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Full text of "A manual of general pathology. For the use of students and practitioners of medicine"

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MANUAL 



OF 



GENERAL PATHOLOGY. 



FOB TnE USE OP 



STUDENTS AND PRACTITIONERS OF MEDICINE. 



. . . .BY > 



ERNST WAGNER, M.D., 

PROFH5S4IR OF CEKEKAL FATHOLOCV ANP rATHOLOCICAL ANATOMY IN IIIK I'MIVUKtVITV l)K I.EII'ZIG: 
DIKECTOK OF THK MUUICAL I'OLICLtMC OF mirziu. 



TRANSLATED FROM THE SIXTH OERifAN EDlTlOy 



JOHN VAN DUYN, A.M., Ml)., 

HliCiFKSMJK OF ANATOMV AND IllSTOUitlV IN TUB MCtliCAL SUIKH'L l)F SVKACIVSI? CNlVICHsirV, N, V. 



E. C. SEUUTN, M.D., 

CLI'ilt/AL 1'R1JFE=.W>H OF l>inBASE3 OK THK MlStl ASn NEKVUI.S SVSTHM IN THR IXIXKCf! OF )'ilVSIi.'IAN5 




N E W YO K K: 
WILLIAM WOOD tt COMPANY. 

1^ 



* * .*• 



• • • • • ■ • 

• •*■■••• 
••• •■•• •• •■• 



Buterad, aocxirdinR to Act of CoiiKrew. In tbe jVHr 1876, bj 

WILLIAM WOOD k CO., 
In the Offloe of th« Librarian of Coagrem at Waotiington. 



Aii Rights Reserved. 



John F. Trow & Son, 

STKRBOTYraRS AND PHtNTEKS, 

30S-3I] Katt latA Si., 

NEW YORK. 



'-1- 



' 111 
/I3y. 



EDITOR'S PREFACE. 



After perusiug the fifth edition of Wagner's Pathology in 1872 I waa 
sti-ongly impressed with the idea that it was well worthy of reproduction in 
this countiy. Ko book iu tlie English language gives such a thorough 
resume of the elements of medicine, and in none is the matter ho arranged 
as to be available for both tlie student and the practitioner. This, the 
sixth German edition, is much improved, many references to publications 
in 1872 having l>een inserted ; in many chapters the work is fully up to 
date. This elaboration is perhaps most evident in the sections on tlie 
theories of fever ; where knowledge which could only be obtained by 
laborious work in a lai^ city library is condensed within the compass of a 
few pages. 

I have permitted myself to make very few changes from the original ; 
two or three pages from tlie sections on soil and climate, and some short 
paragi'aphs iu the chapter on fever, have been omitted. A few foot-notes 
and bibliographical references (chiefly Ameiican), and an index of authors, 
have bt^eii added. 

My friend Dr. Van Duyn has translated at least two-thirds of tlie book. 
The proof-reading and arrangement of the work have fallen to my sliare. hi 
our translation we have encountered some tlifficultjes, and those who have 
done the same kind of work will know liow to make allowance for a num- 
ber of awkward sentences in the Knglish. We have endeavored to Ikj 
literal and at the same time clear ; and elegance of stylo has not been 
aimed at. 

The metric measures and the centigrade tbormometric scale have bcLMi 
retained. I have done this in order to aid in ditfuaing knowledge of these 
now national standards, and to do a trifle toward bringing medical ob- 
servers in tliis country into closer communion with the general scientific 
bcnly. 

E. C. Seguin. 
Xew York, January, 187ft. 



PREFACE TO THE FIRST GERM.O EDITION. 



TuE authors of this work were closely united for nine years by common 
scientific interest and most intimate friendship, until the death of Uule, in 
1801, aevei-ed tlie relationship. As long as botli of us labored at the same 
University, and in the same city, questions closely connected with general 
pathology formed the subject-matter of almost daily converse ; and hence the 
wish was often expressed that we should together write a manual on this 
subject. The execution of this plan was provisionally thwarted by the 
calling of one of us to a distant University. 

For the possibility of fulfilling this long-postponed design, T am indebted 
to Uiile's widow, who bequeathed all his manuscripts to me. Upon perus- 
ing them I discovered that Uhle had carefully elaborated just those chaj>- 
tei-8 which had been only incompletely filled in my work. This book is the 
ju-oduct of the union of both manuscri])ts. 

As regards the division of labor, it should be stated that the fvcut part in 
plan and for the greater part in execution is by me ; the second part, with 
the exception of the lust chapter, by UiiLE ; the third part is mine, with the 
exception of some passages in various chapters, and of the article *' Fever," 
which was planned by UllLE. 

Thus much in regard to the origin of the book. As regiirds the concep- 
tion of the whole, the grounds upon which this conception was based, and 
all other points, the work must speak for itself. 

E. Wacxer. 
Letfziq, JUarefi, 1863. 



PKEFACE TO THE SIXTH GERMAN EDITION. 



The present edition has been augmented iu every part. It has thus be- 
come more vohimtnous than I might have wished ; but I hope that the 
utility of the book has not been injured by this, because I have as much 
as ])0£;sible endeavored to thoroughly sift important facts on the one hand, 
and on the other to present in smaller type documentary evidence and mat- 
ters of less importance. 

The prejiai-tttion of this edition has been more difficult than that of the 
others, chiefly because of three evils with which our literature is afflicted. 
These are : in the first place, the preliminary communications which usually 
are not followed by confirmatory statements ; second, the large number 
of publications about experiments which are occasionally useless ; and, 
third, the present condition of the question of fungic diseases. 

For the account of Fever, and for sevtM-iil sections on astiology (Groxmd, 
C'limate, Dwelling), I am indebted to I'rof. Thomas. I also wish to ex- 
pi-ess my thanks to Piof. HcprEitT {5th Ed.), and to Prof. F. IIofmaKN 
(tith Ed.), for many chemical exphinations. 

E. Wagner. 



LfiLEc^RjDONTBNTS. 

PIQK 

editor's preface iii 

Author's prefaces iv 

PART FIRST. 

GENERAL NOSOLOOT. 

Oeneral conception and forms of morbid statea t 

Nature of diseaae 3 

Extension of diseaae 8 

Sources of general patholc^y 6 

Gleneial symptomatologj and diagnosis 8 

General prt^nosis 18 

Duration of disease 18 

Course of disease 14 

Termination of disease 18 

do. by cure 18 

do. by death 34 

Agony 25 

Apparent death 26 

Causes of death 84 

PART SECOND. 

GENERAL ETIOLOGY. 

CaTTSES, PREDISroaiNG AND EXCmNO 87 

I, Internal causes 39 

1. Inheritance 39 

2. Age 43 

3. Sex 50 

4. Coustitution, habitus, temperament 53 

II. External causes 55 

1. Atmospheric influences 55 

a. Atmospheric pressure 55 

b. Atmospheric temperature 57 

c. Moisture of the nir 63 

d. Composition of the air Q^i 

e. Electricity of the atmosphere 6(i 

f. Movements of the air 67 

g. Light 67 

2. The Roii 08 

3. The climate 70 

4. The dwelling 72 

5. Clothing and bedding 74 

6. Food and drink 80 

7. Occupation, profession, etc 81 

8. Parasites 83 



VIU TABLE OF CONTESTS. 

PI 01 

A. V^r^tablc parasites 84 

I. Mould -diseases, or mykoRcs 05 

II. Fungi of true parasitic diseasCB 9.^ 

III. do. OS exciters of lermentation, etc 1(K) 

B. Animal parasites 109 

I. Protozoa Ill 

II. Vermes, worms 1 IS 

1. CloAs, Piatoues, liat-worms lilt 

Order. Cestoidea, tape-worms 113 

Order, Treiiiatodes. sueker-wonns 120 

2. Class. Nematelmia, rouud worms 122 

in. Artbropoda 127 

9. ContagioDH and mianmata lltO 

Epidemics and endemics li}0 



PART THIRD. 

ORNERAL I'ATnOLOUICAL ANATOMY AND FHY8I0L00Y. 

I. Local dibtukbanceb ok thk cikculation 1 45 

1. Anoimin, iscbsoniia l(j*> 

2. HyjierBemia. 173 

A. Active or arterial hj-penemia 173 

B. Passive or mechanical hypencmia 18(1 

3. Thromlwsis and embolism 188 

A. Throinboaia 1 89 

B. Embolism 199 

4. Hwmorrhage 210 

5. Dropsy 224 

Pneamatosis 23t> 

II. Inklammation 241 

Causes of inflammation 243 

Phenomena of inflammation 245 

Inflammatory hyperajmia 252 

do. exuiiation and suppuration 255 

do. new-formation 270 

Symptoms of inflammation 27;i 

Divisions of inflammation 277 

III. GENKUAL DI(iiTLlt»ANCK8 OF NUTHITION 280 

1. Imperfect nutrition, or retrograde metamorphosis, atrophy 2^7 

A. Hiraple (quantitative) atrophy 293 

B. Degenerations, or qualitative atrophy 297 

a. Albuminous infiltration. 298 

b. Fatty infiltration 300 

Fatty metamorphosis 301 

c. Pigmentary infiltration 309 

d. Calcification and petrifaction 310 

Calculous formation 319 

e. Lardaceous, or amyloid degeneration 33*3 

Corpora amylacea 327 

Myi'lin 32^ 

f. CoUoid metamorphoaia 32J 

g. Mucous do. i\A'i 

h. CEdeniatous, or serous infiltration 3;i4 

i. Croupous metamorphosis 335 

2. Gangrene 33tf 

8. I*rogres.*«ve metamorphoMs : 

Regeneration, liypertrojihy, tumors 353 

I. New -formation of connective tissue and of vetwels 370 

1. New-formation of connective tis.-*ue 371 

2. do. of vesf<elH 374 

A. do. of va.'fculnr connective tissue a» regene- 
ration, or as cicittricial tissue (healing) 376 



TABLE OF CONTEXTS. IX 

PAOB 

B. Xew formation of vaHCular connective tisBue in the 
form of connective tissue hyper- 
trophy or imluration St^'2 

C do. of vascular connective tissue in the 

form of connective tisxae tumor. . 38.1 

Fibroma Il^t-'i 

Myxoma HUl 

D. Vascular tnmor. or angioma 'I'Mi 

E. New-formatioD of raricular connective tissue in form of 

papilla; with epithelial covering. Papilloma ^r!2 

IL New-formatiou of endothelium ;ii)4 

HI. do, of neuroglia 89'( 

IV. do. of fatty tissue tiOH 

V. do. of elastic tissue 40.1 

VI, do. of osseous tissne 404 

VII. do. of cartilaginous tirtsue 414 

VIII. do. of muscular tissne 41?^ 

IX. do. of ner\-ous tissue 42:3 

X. Hctero]>lasiGe, or heterologous new-formattonof councctive tissue, 

etc 427 

1 . Sarcoma 427 

Psammomn -. 48:1 

2. Syphiloma 434 

3. Lupus 4>i7 

4. Lepra 4:1"^ 

5. Connective tissue cancer 4;!!l 

XI. New-formation of cyiogcnic ti.s.siuc 4:i!l 

A. Hyiicrplaatic formation u± cytogirnic tisttud 440 

B. Heteroplasiu;. or heterologous foruiatiou of oytogonic tissue 44i! 

1 . Tubercle 444 

Scrofulosis 4")7 

2. Lymphatic new-formation ; lymphoma 4-')!l 

XIL New- formation of tme ej)itheiinm 4(il 

1 , Xew-f orniacion of epithelium alone 4ii'i 

2. do. of epithelium and of vascular connective 

tisNue . 4ft!l 

•i. do. of glandular ti.'<sue ; adenoma 472 

XIII. Caucer or car^-inoma 477 

A. Epithclinl cancer : epithelioma 4^^ 

B. Eiidotlieliid cancer oCI 

C Connective tissue cancer 501 

XIV. Cvsta. encysted tumor, cystoma 504 

XV. Combined new-t'(>rmati.ms. mixed tumors ~tl4i 

PART FOUUTII. 

r.vTtionKjY OF Tin: ni.oon. 

General considerations 51 'I 

I. AnnnialieH of the size a;iil shape of bloorl-cnrpuHeles 517 

II. Anannia iu general 51)S 

1. Acute ana'inia, or uligaMuia 510 

2. Chronic anieiuia 520 

a. ChroTiic anaemia from diieet or iiirliieet Irss nf blodd 52IJ 

b. do. by le.sticni.T.1 supply of fuod : iiianition-ana,'niia 527 

Chlorosis r);j5 

Addisoirs discjisc !i'-Ui 

III. Changes iu the anion iit of h:e!n<i^'-liliin in (lie lili»ijd 5;t7 

IV. Chanires in the aiiumnt cf albuun.;i in the Mood 5;i7 

1. Hypalimininosis 5oS 

2. Hy]M?rall)uiiiinosis 5.il( 

V. Chitn;.;.-e in the amount of water in thu IiIiuhI 540 

1. Uiuiiuutiou of the aniount of water in the IiIo<h1 540 

2. lucreaso of the amount of water in the blood 541 



3: TABLE OF CONTENTS. 

m 

VI. ExcesR of fat in the blood 543 

YIL Changes in the fibrin of the blood 54)2 

VUL Plethora 543 

IX. LencooythBBtnia 54o 

Pseudo-leucocythMmia (adenia) 548 

X. Melaoffimia 549 

XI, Icterus, jaundice 550 

1 . Mechanical, or hepatogenic jaundice 551 

2. Chemical, or hacmatogenic jaundice 550 

XII. Suffocation 557 

XIII. Uraemia 570 

Animonisemia 575 

Hydrothionsemia , 576 

Acetonemia 577 

Uric acid dyscrasia. 577 

True gout, podagra 577 

XIV. Diabetes roellitue, glycosuria 57fl 

do. inaipiduB, polyuria. 585 

do. inosituB 585 

XV. Pyaemia (aeptico-pyaimia). 585 

1. SepticsBmia, or ichorrhsemia 587 

2. Embolic pyaemia, pyEemia proper 588 

XVI. Fever fi03 

A. Symptoms of fever 603 

B. Regulation of animal heat 648 

C. Historical sketch of recent theories of fever 684 

XVII. Marasmus 697 

1. Senile marasmns 608 

2. Marasmus as a result of disease 702 

XVIII. Haamorrhagic diathesis 703 

Table of weights and measures 706 

Index of authora 707 

do. of subjects 710 



PART FIRST. 



GENERAL NOSOLOGY. 



GENERAL CONCEPTION AND FORMS OF MORBID STATES. 

Pathology is the knowledge of disease ; general pathology is the 
knowledge of the morbid state and of diseajie in general ; special pathol- 
ogy is the knowledge of individual diseases. 

It is impossible to give a. short and clear definition of diseaRP. Usually 
disease is referred to as the condition opposed to health. Both expressions 
are in common use. 

Tliat individual is healthy, in whom the more important phenomena of 
life (nutrition in its widest sense, development, and reproduction ; move- 
ment, sensation, and psychical activity) take place quietly and uniformly, 
and who has the sense of well-being. If we attempt to make the conception 
of health more clearly defined, it is easy to fall into absurdities. For, in a 
scientific conception of health, it is necessary to suppose that not only all 
parts of the body perform their normal functions, but also that they are 
normally nssociated. And yet in this there may occur great deviations from 
the ideal type, and the affected person remain well and live long. In a 
strict scieiititic sense, it may be said tJiat no one is healthy. 

He is sick in the sense above referred to, in whom the phenomena of life 
are disturbed, or upon whom external physical and chemical agencies act 
with imwonted energy. In consequence, the affected i)erson usually has 
a feeling of ill-health. Yet this conception of sickness is too limited ; since 
a i)erson may for a time appear to exhibit normally performed functions, 
and may liave tlie feeling of complete health, and yet be seriously ill. 

Consequently, in the conception of disease, we must include not merely 
modifications in the stiite of feeling and in the performance of function, but 
also the more considerable alterations of the normal structure, and composi- 
tion of single or numerous organs. 

It follows that health and sickness are only relative and conventional con- 
cei)tions ; that the healthy state very gradually passes by many intermediate 
conditions into the decidedly sick state ; that health and disease are not 
absoluti; oppositea. 

Sufficient synonyms of the word disease are the expressions complaint, 
affection, disorder. Others are occasionally made use of, as, for example, 
abnormality, which are not exact e<]uivalents, because wliile the conception 
of the normal is ideally well defined and invariable, that of liealth is broad, 
and an individiuil may be said to be perfectly healthy in si)ite of the pres- 
ence of various abnormalities (scars, defective external parts, absence of one 
kidney, etc.) ; the abnormalities only becoming diseases when tliey iuter- 
1 



3 GENERAL PATHOLOOT. 

fere with important functions, produce pain, etc. Lastly, several expres- 
sions are in use to convey the notion of slight sickness, as, for example, 
indisposition ; and to exjiress such conditions as arise in consequence of dis- 
ease, but which are partially cured, or which can have no intluenoo upon 
the general organism. The words malforniation, deformity, are applied to 
such as occur in ftetal life, and defect, vitium (for example, amputation- 
stumps, mutilations, warts, etc.), to those aiising after bii-th. 

The so-called feeble health (bodily weakness, valetudinary state) is easily 
changed into disease by the action of slight causes. It is congenital or ac- 
quired. It is often met with in the convalescence from severe diseases. It 
is not rarely simulated by a progressive disease which cannot be diagnosed 
in that eai-ly period ; as, for example, phthisis. 

The disturbances which constitute disease are ANATOMico-PATnoLOOiCAL 
(that is to say, histological), or, chemico- pathological, or functional. 

Anatomico-patholooioal and hi.stologico-pathologicii!, or morjihological 
alterations (defects of form) are all those in which the physical relations of 
the part are changed. These changes consist sometimes in general swelling 
(inflammation of the subcutaneous connective tissue), sometimes in altei-ar 
tions of consistence (thickening of the skin, softening of the brain), some- 
times in the filling or coating of surfaces, previously exposed to the air, with 
dense material (laryngeal croup, inflammation of the lungs), sometimes in 
disturbance of relations (woundsi), sometimes in microscoi)ical changes in 
the cell-contents (fatty change, etc.). 

CiiEMico- PATHOLOGICAL disorders (defects of composition) are either such 
as manifest themselves by altered quantity of a chemical ingredient of the 
body, as variable amounts of blood constituents, urinary substances, etc., 
or by altered quality of the same, as, for example, change in the fibrin 
after frequent venesections ; or such as consist in the existence of an in- 
gredient in an abnoimal situation, or in abnormal quantities, as albumen or 
sugar in the urine, urea or bile in the blood, uric acid in joints. 

Alterations of form and composition always appear together. Tliis fol- 
lows from the processes of growth and nutrition in the healthy state, in 
which the formation of a single cell without chemical activity is unimagin- 
able. And we also have a proof of this in the direct observation of the 
majority of those diseases which have been studied histologically and 
chemically. 

Functional or symptomatic (or dynamical) disorders are those in which 
we have, as yet, been unable to detect any material lesion. Tliis, for 
example, is often the case in pain and convulsions. And yet in these con- 
ditions we must admit the existence of delicate material alterations, wMch 
are not recognizable with our present means of investigation. 

In many cases it is furthermore important to i-ecognize an affection as 
IDIOPATHIC or symptomatic : it is called symptomatic if another cause is 
present to account for the general phenomena, especially fever, as for 
example, roseola in typhoid fever, ker2)€8 lahlalis in intermittent fever, 
pneumonia, etc. ; contrarilj-, when no other cause for the general symptoms, 
particularly fever, can be made out, the affection is called idiopathic, aa 
roseola sestiva, anturanalis, herjws of the lip, eta 

Every alteration has a defined seat. The causes of disease do not usually 
affect the whole body, but only a portion of it ; at times a tissue, an organ, 
or a part of an organ, at times a system of tissues or organs. In the 
affected part there must next ensue a specified change in substance, an 
anatomical or a chemical alteration, or both together ; so that we may 
nmintain that, at least in the beginning, every alteration is local. It \a 



GENERAL V<36OtJ00Y. 



3 



]iOsftib1e thai the poet mortrm exaiuioatiou uf tho nrgnna and tisiiUQsdoos rot 
cunblfT u<i tu (lt^i</t-iiiiiio tliiii locitlualiou with certainty; aiinU)niu;Al iiivv«it- 
gutinn tA n.il tlin niilv mwins of eontiibiitiug kDowlw!g« to pathology. 

LtH'AL. ni:>EASEs ut'o I'Cnli'ictcd to a tissuL-, un orgiin, or a ]>ortioii of one, 
dating tlietr wjiole c-xitt<-ncu (loc-ul dutcaai's, local aifrcctioiia) ; or Uioy may 
extftid, ur Wcome g^iiei-Hli?jfd. 

Extension of i>ibeabE takes ])lnc-e in tlireo iiriiici|Hil ways: litt, by 
continuity uiid by contiguity ; 2d, by way of the blouil untl the lyniph ; 3d, 
tliratigh simihirity in thu Kltnictiirv and liiiH'lion!i of lii^ues ami orgniia. 

The kxtension of mskask by iostinuity and i.oxTiotjiTV in imuily 
di*uiuniitnililo by siiftii-iriil miulomiail kiKiwIeilge. Wo 8i*e, for tustanop, a 
spr).>udtng by ctnitinuily in thti LMtjurbal iuflurninciliun of tbi* na«al luucoim 
iitvmbian*^, vhich may L'xtvnd to the frontal sinuses, to tbo antrum of 
lli^jbmure, 8omctitne» to tho lHvhr};inal diicltf aiul o»rijniictiv!c, or to the 
KuBiacbiau tubes luul tho iniiidlo cur. lo th« chi'ek» aud jtharynx, somiicimea 
to tb** larynx, Imcbeo, anti bi-ouchiid tubfia. An exteiiaion by contiguity 
we moat with in luany uflt'ctiona of the serous niumljnuies ; a prnj^rchsing 
iutiauiuatirii) of tlio >itamac'h or ititi>»tiiial canal frequently pi'oducvH iiiiluui- 
nuiti(;u of the contiguous jiart of thr* paticlul or hulMUc sorous niombiuuo. 
Tho extension of diaeaw* by continuity and by L-outignity togetlivr, wo see 
best ilhtHtt-at«tt in the wji'ouk UKMubrancK. A Ktt[HM'ncia] gungi-tiiii^ focuK in 
tht* lung tbiKUU will, for ininitancc, causo a coii»i'culivir iiilhininniUon of the 
pnlinoimry plennL just u^'L'r it, and tbiN^ in its turn, will (.'xt).Mid by contiuuily 
ovur iJii* ixnnuindcr uf th<.< pulmonary plnura, aud by coutigmly to tho cu&tol 
or diaphiTi^umtic ptuura. 

TTti ■■■..< - —1- - Tipg tho sprpadiuR- of intlammiLiou takes place in diffL-rent 

wo.-^ .t of ill*' jiniuar)- iullammatoiy foooa. In the ucii'h^inrhi'od 

of(!' -, - .-::.. j -L nor o?pfi:t ^'f tlifl lung, at tlie plare of origin of tlitr (jre-at 
t«»vIa from tho hvurt. at tbo rolativclj immov&bic sc};nir-nt of the stnranoh ittie 
aniaJler connluit:) and tbu iutcsiliual cuiiiil lurciiniK Itie inllammation more ranfly 
Teinttttia L-iruuinincribtMl, whiU; iu ntlivr uiuuh iiloru muvablo purtit of tho iiiouibriiiK« it 
L'Xt<iuilti uuiily thnvii^rliuut the lattnr. Tu j'onug bid iTuIaaU tUsejuK-a of tbi! eptfiliyitCii 
•*;!'! Mo ih<! dijipliv-ii'ii; which w tt'.vountcil for by tli« fact that lh« f-jiijihyKen 

an*': Iiqvh ra.'li tlii'ir proper hlnod vfispU, which, for the mn.st part. On Dob 

ciniii Aith Pdoh other. In thw coiinoftion wc iui{;ht iiieotinn manv iiifvpli- 

catAc pht'nniDfcua. WhftrRiijj, fur L'xmuplo. Liinwr of tho cardiac orlfloc always iiEpli- 
cates - •M[ji:r i>r Int^r, lh« Htouiach and a-aopha^ua, cancer of the pjr!oru<i seldom 
att^ I r'<]t'iiaiii. 

'1 n »r (tiK^no^ by oontinnlty and by oontignlty raust bo undorato'-Kl to bo 

taC iBf?. To til- ■■ i>i«6 the ifUition of partaisvcry variable 

in ■■■ ■ times thi- ' Lilly out- upon another (<^pit'»<'lia »'IUl. 

or i; ,v i fnxti taxf. .nt-^u,- i ..v iiit^-nttitial Kubi^taucc, or coMUL>ct«d by 

mt: .T'>rpuK'*l(H of c<iiiii<:<;I:r>; Lif*.Mi>;, houii-i:<irpusc:lt.'». gaagliuu-celU), 

or i: . I illy iwilat«il in a hinflnmtutiJ liraut* (cjirf.Iajj«-t:cll»). 



Tkk KXTCxaioN or diseasb tijiiougu tiib Bt/)oD AND Lviiru occurs in 
one of thi-w ways. The substaucf--* containrd in the vessels are carried 
forward by the I'uri'ent of blood or lymph, aiid depoailed in other parU of 
tJie laaciilar ayhtttm (coagula, bitH of valvi-x, etc.) ; or, substanw.*a originating 
ouLsidc of thpiw vcsM'ls entfir tlipm (biJe. urt-a, nrii; acid, lime-salts, fat^ 
e*r.); or, lastly, when bubataiiccs from without tho body tuilwr tho vascular 
ttyatetu (duat, para»itca, jioisunifj. 

The sruEkiii^tn op biHKAi<E in £IUilar rmsnEs on simclae orcans 
dor* nut at the present time admit of any aatisfuctory expluitntion, uuh'aa 
the hiniobigical and physiological identity of thti blood and ihe ncrvc-s, ua 
well all Ute caiiaal influtuieea, Im taken into coiusideratiou. As examples of 



4 GENFRU. TATnOLOOT. 

this Bort of extcnaion, wo mny cite ati'c^ction8 of tho connective tissue 
of cxt«riiat and iiiWruul [nirUi ^itifliiuiiuutioi)); of the lx}iie» (inflaiumatiun, 
tnhnrculosU) ; of riie juitiU (arucitlai- rht* iniiatisiji) ; of the serous meuibrunes 
(iiiHimimntion, tubei-ciih>»is, caneer); of tho skin (iniuiy forms of erytlieiiia, 
t!)7aipel[iB, ecj;uiim, [Moiiusiti, sy|ibilideK, btc.), luid diKeasoii of duublii 
Di'gaiiR, cBjiecially the eyen Hnd kiilnevH. 

^Vhe^eu, most double oi^aiia are srinineLri all^dlHeaaeil, or ikC If Ast ccr Lain diMMBB 
mniiifmfc tJiemsclTes synimutricalij' ^taberouloitis cf ihv Iudrh. sjpbilis of the tostM, 
mflommntion of tbe Iddiier. aiid the kidoojr ullections knovrn hj tho tuune of Bri^fbi'* 
disciue, CU!-). tb<«ro arc moa^ dit<cas(.-a which appear ooly in ono of tho double 
oiifCauH (*». for exaiiipie, primary canour of the eyeball, of the biag. of th« kiducy. 
tOBtiH). Tbu JH alfio in part tme of both siduH of tbe heart, thti braiji, the tlirroid 

[ As rL'panl* ibo extenwni] nt disoiwo through the niodlnra of the nerves, that la to 
1^. in a rellpx way, our kuowludKQ in as yvi so imperfect tbut we bnve no winh 

to »otar([e upon it here. That tliiit <]ol« taXe pluoe in the aboveuameil wajr, bjr 

Tellexloi) Croia nouRoriai. timutiUro, and niot'U' ufxi't^K uprm HympathfUc uervca, baa 

beeo raudiTed o«rtaiu by ruu-'archoii npiin the syiupathetic. 
The sn-called gjmpathotic afToctloDa of Uie eyes are of great pnurtical intornt in 

Uiia respect (voN (jit-fiFK. MuoiiKN. and others. Conmilt I'Kri'sri.i.KR, AreM. 9. 

IMUf., l«7l. xiL. p. 21U; POOLh'i'. N. Y. Hfntical Jourml, Oct. I«:0>. 

GcKGAAL OR cosfSTiTnTiONAL DiSGAttus iitTect oitliHr th« oiitirR orgoninm, 
or ftov»rraI dilTereut urjpwis, or tissue- maxsi-w. Thohc gtiiieral ditteoaes in 
which altei-od compoMtion of tho btrKid is driiiouKtrabltt arc callrd dy^ciiiain!, 
blood-tiiseasea <for example, chlorosU, icterus, HiinMtUH) : those which 
1>t*ooiiio general through thu niudiitin of tho blood, whrn llio blond hita 
])ro1mblY taken np name poiHun, wit}iniit an cvidont chun;;e in the conipf^si- 
tiou of tbiii tluid, wo uamo intoxicjiticnia, or iiifoetioos, toxio diaeaites; 
iiitoxicHtion, whtrn the iiijtLnuus &iib»tuuce i^ derived from tho in<.(r^Hnic 
or vegiit;dil«:' kingdoms {e.ff., lend poihoning, ujiiiuii inioxifation, phdwhiy 
malaiial <UfMjrdei>) ; Infeetiou, if tho poinoii ut received from a disomod 
animal {e.g., gUtmlei-s, utithnw, liydi'Ophohiu), or from n diseawfl hniuan 
being {tf.(/-, inpaalea, ant]dl-{K>x, hiccough, typhoid fever, chottira, i^philiit). 

BVRN JK THE CAHK OP IIII.NKRAI. I>R CONSTITnTrONAI. DISBASRP, THE I-EPIOSS 
TraiiALi.v iNvm.VR twii..vTKO KLKUENTB. If vory man/ local disorders exist, tho 
dteoaae apiKsars to be gvnernl Ixtaiisc of ita uuracioua foci. Vim now ba« ptirtiim- 
lacly caJbM atCt'iiUoo t-D tb>-' cxiftvuoe of Miuh local morbid coadiliotiB in ijL-ueruI di«- 
eaaaa, even in iLuir latent otJ^^ua {an in Krpluliit). 

The expreKnion loniliuttiiin uf <li)4*!ju(u implioa thnt ibo morbid itat« is nt first 
(^oeral unci ai'l4>ru-ar<l lM>ui>m<« K>aiil. The kuowbtdg'n of the local linportouoe of 
every dinoTilcr cwntrwlictn thiii assumption, Aud jet, the d-Mitrine of the locaUia- 
tiOD of some f;cnt-ral dittcaaeA in crrmiii Bta^en la nomuUmcA correct. In ucailj all 
iDtoxicitioiu) tbe poison, be it lo.id. tnt-o-^ilL-fi, or typboid-fever poi)i<m, tirnt makes a 
looal impn-Miinn ; it cnlarB the bliMKl tbroiij^h iJit! digcHtivn <ir n-f^pirutory iin^iu, 
aftvr which thvrc flapif* a (*rrtaiii ptrioil cif time, during which it in iiopoiuible to 
aaj in what part of tbe body ibo auUtuqiiout morbid lu.iioiu will appear. When 
tb<»o laat iLfe pcrct'ptible, It in mu<1 that Lht.* di^uiHu lm» UrCiili/.ed itself here aud 
there. The ex{iruciiaii hoR Ulirwine h^'i^ii *Miiplo.v<-iI to <b'><ij;iiuLi.' dL-ii-u^cs wliicb llave 
alwaya bocn rrcoguizmi a» local ; an, for nxamplc, inllnmmntion f>t llio biii^. In 
thin diwano ihrrc often pa*w by one or two, or even thrfe or five days, in wlii*-h the 
pyinptoiiiK of a •^vere illnnss arc rocoffoiaed. bnt id which th<>m are no sigUK pointing 
to the longs aa the (*eat of the affection. It it bu said that tbe tlificnso hot ]ix!aliiicd 
itiielf iQ tbL< lunik's, we ouly mean that the local atortiuj,'- point of tbe disonlcr «>ould 
not Muoncr Imi reL-ogtiizcd. 

Thf^r*' are Kt.il other modett of conception of dtaoaBe which hare been maile nu nf 
to d("<ignat«! tt-ndeuuips in mpdicine. 

JuKt aa pnthotn^iNtn nt various tiniex bnve considered the hnnior< or the Holid parta 
of tbe body as the Atartiu^ ]H>mCti and cbaaaeU of projiagatiou of diacaao, >o pby- 



OEKERAr. xosorxfCT. 



ihftvif ditttirgui^tictl tht^nmnlvt'ii as llv>luu\Llin'6 or »)l.ini!4Ts. Amou|f imliil- 

r Hm s»'.rB(i-PA'riiiPUitiiHr> and cei-lituak I'ATiUH.imi'iT'i umt-L W. nKipaniMy 

F dai lgpated. It \s thi- nim nf f^lhilnr [Mithol'g'y to pinix.* our annt-t^mical notloDx nf 
Oiaeaae upon an hii^ti'IuKiual fouiHUuon, >>., bo cuiuicct tbrm wiUi ibe Mimllutt 
iiiUgr*! [Kirts wttich t)ie niLcr(iHOW|ie i3Ui diiM:ovcr. It in imimrtuut euougb tLul uui 
(^tieral n<*lioas thonld lie (ieuMon-k.1 iu ai> tnr na in ]M>i<»ililu; but it vftut lua errvr to 
»ti)>p(iM.- ibal Lvlliilnr |tilli(tli>'.'T fnl.rut*t:<l ibt wholti of patbolt>gy. For tho Uttor the 
blood mi'l n>*rv r rt uit nn tli<* w-IU of ori{an«- 

Id vorSi'-T II "<1 npon i\* iiometbing forcij^n to the orgnntsm. as 

jwroftbittif fiir .,1-1-1 ii. a:. --iNi-iiiiiig .'(•'piinite from tbe hie o( the body. This 

coiicvt>nuii, ni-c^.r<liii;,' Ui wtiiuli liiscaw; wsm a piutioular tiititj- \oi», ra»,] wbiidt lod{p:<t 
iu thv (lovl^v. M»M railcil otil.>i>ii^L'al, Miuiy wont ko fur ua Lo H]K;ak of dbfOiMe ait <uii- 
bmliml iM.tn)' t-Xi<rv-^.H.i>iiH t>LilI in (:f>iir.mkit iikh, nn " the dtwaMi ftttRdot Uie boily," 
" th« boily KLrn^^k'S ntib tbt) ilimnxv," " tbe phyHiniui combatA the dincjue," "na- 
ture has ovi^rcioin*.' thi^ dli^tuw." olc. starve to rumind tu of Uie older notiona 

A^ain. medical lafii bave been deaJKUated us F.MPIKK IsTt* and ItATIoNAJJBTS in 
liuituu> of |>;itbolojfy. but more iu rci;ii.n1 to therainnitio. lie i^ an cmpirieitil who 
reawins »h lilUi! tui puMHible, diM-o nuL <;(>iit»;rii biiiiM^r nbfuit ihu pxplanatJnoH of 
•frpttfntf «3Tii ptoinis or of Lbe miKbi oj Action tif niedicaniuiitn. but who ntlion i"io ex- 
wrieiKe. If be Iw old iu jear». and ii|M in so-called pnu'tical oxporienct;. he will 
attach c^pocial iiuiKirta.ui.t; to bis uwu obricrvatiuut. Ou the contrary, tbu!>Q physi- 
ciiuw uv called rftttoiinlmts who do not value the facts thcm.sc!ve« so binlily a* their 
cxpIaunliuD, aud waoHeclt tbu advaucu of [lathnl.g'y in tb« ciiiitti>t.-tijig of vvery morlud 
uiauif'vtutalioit imim-diatAly wtUi phyeiologieal data. Prom tbiii, howevt^r, nothing 
call i-9tafi but u luitholn;^ who!<e fiu-l« are takt^u from Um side, toj^lhur uiili eori^uil 
luwociatt'd pby-'- ■■ ■• l'y|Kitb';-e«. 

L««lly, lii'v AWTiiMK'Ai. aud PllvsioLoatCAl. mi-dicine. The onatom- 

tckl «rlik')ol biiM .^ ilh tbv bivi-t<ti|;atiua of anatouilt^ uhnngca in tbt* diMiaMxl 

oi^uia and their rfiauou vrith the sjiiipLams fxhibitml during life. All important 
prarron in medicine has lieeu dopoudvnt upon anaComteo-patbolf^jflua) ditwoverien. 
Cp to thti prcM-'ut time no motbud of ntudy lias inmctratud mi foi' uiwacdfl tho seot 
aud tauMca of diMJosc aa paLbohti^irnl nuntnmy. The- auatotuiciil eliidy of dlMiasu, lu 
well OM ilH bimti^l'i^ri'-al or cellular Htudr, in iirovixioually the most Milid Uvis for our 
tvaitoniDg. Auil y<:t patbulo^ical auaioiuy cannot Ity itwtlf uxplaia thn rolations 
of pheuomcnu in lh« Birk ; ibiji ia b>;t5t dotie by & knowledge of mqi ilar prooi-s.iK^'a iu 
the hcAltb> Ifody, and tbc titiidy of lunrhid proot^tnes by all the incthida whiuh oro 
aseii i-i i<hT~i<ilo^y fiir tbn iuvuittit^atiou of tbu funcUouauf the noriuol l>ody. This 
in ]!' 1 mL-dicine, 

'I': ir.em and im|)ortJmo« of the pretension to build np pathology upon a 

phj -I'l'-^n'-ii I , - HpQu tht'fH) two ooOBidortttioas. Fir«l. it 'u imocwmry to 

TuiiinlaiQ the' • notion that morbid proct^sscs do not efiKentioJIy differ from 

QOTiual <iiu;^ . .. ,, ...- . Kid tiriu)fi.>t ili'.'ii *iud)4 iU aoalo^n<'-, in phyHioIogical oontli- 
tiiHiH alid pnJtSMMtM. 't'httre luvi no upt'i-ific obt*nik'o-patbobigi(^d tiodlui. Ltrucin and 
typioin, wbinh wi-ru brntced npnn t>y ttipjr diiwovt^rt^r an U»* caiinc of the nc-rvous 
»yiiipi«>in« in atrophy of tb* liver, were hoou proven to bu utnal couBtituenta of thu 
healthy body. There ore ao specific p&iholotrical fonod. It n'oa bvliuvt^d, a whilu 
n^o, that ituciUiurly foriuvd ct-lln could bu )taid to exi^t in tiibcTclo, sarcoma, cnnoor : 
a stdtciucuL which ban Im-v-u i<hiiu-n to U; falw\ Tbf n; arc uo apcciUu jKitboUt^^itial 
^Tnpl'mij- ; ■v- "■• mns pulse, whioh in only mot with in morbid KtaUyt, has iUt 
auajo-^ie III ti:> ;<ultw. 

We iiiay. ai t ...'ue by VlKcifow, devi^atu tlie gencrol morbiii proonsaea as 

UKttiliMCiltto.Mi.' and iibTLinurulMC : that i-4 to etay, oj piooctuon w hi oh would be 
coilcfl uoruial, did tfai-y take jdacv ut a difFi;rcnt time or in a different bpoL For 
tJtotuplc, all itlfupiim of bUidd in the ovniy at the tinm of menstruation is ucirmal; 
ou f (tuiuun ot blood into thn brain in alway.s abnormal, and ix th« cauM of otbur mor> 
bid pUenoin'-na ; wp have ber-^ tie'lKOoi'oi'lA. HeniorThau« fnun the mucous mnm- 
bnuii.< of thi' ut*_ru» at a curtain time (meiistruutiou) is normal ; at otiier times 
Bbnormal, Ilt^TKKOCltltuKIA. 

There i» no nulical ditTernune between tliP forces and the Kittwtanocs by meoDB of 
which Doniuil ami morbid life in kttpt up ; no im[mrtant ditTt^renue between phy- 
biuli^Mcai and |>atho|MiriiuU Iawh. The ditrtfrence lies in iba condiLions ludor wbioh 
ibc fii(»t-« nfi'l Mil»laufi-» of the boily opeinle. 

T' '.uoii fiicltir which ix f uudauiental in the conoeption of physiolng- 

icnl luaotier in which tho tiltei^il, that it* (<> say. ]<athoki|;iual pho- 

coij ..i< .nve«tit;ntod. This in the sn-bigbly pnuxM phy etiological method. 

However, pbynology knowd no methods sare tho»o of chcmintry, and chcauistry uouo 



6 GENERAL PATHOLOGY. 

Bare those of pbyBics. Sorely a knowledge of diseaiwd life prestipposcB a knowled^ 
of henlthy life ; pathology oKSumes the ezittence of physiology. Pathological phe- 
nomena must be studied by themselves, and though one may be a very g-ood pbysi* 
ologist, and not under«tand all the phenomena of the sick-bed, yet we may speak of 
a pathology built up by Bcientific methods ; although in the strict sense of the word, 
a special physiological medicine is an empty phrase. 

The souroes op general pathology as well as those of practical med- 
icine, are physics, chemistry, anatomy, and physiology. To be more 
particular, there are four branches from which the materials of general 
])athology are chiefly dei-ived : Observation at the Bedside, Experi- 
mentation, Pathological Anatomy, and Pathological Chemistry. 

Observation at the Bedside, which includes tlie special pathology of 
internal and external diseases, as well as all those associated branches which 
have in later years been separated from it, such as pathological chemistry 
and physics, stands in the most intimate relation to general pathology ; every 
progress in tlie former naturally benefits the latter, and vice versa. 

Experimental Pathology presents the same advantages, and is open to 
the same objections as experimental physiology. The real value of the 
experiment consists in that it can be jierformed under determined circum- 
stances of place, time, and conditions; the latter may be indefinitely varied, 
and death can be induced at a precise period after the experiment. These 
advantages are offset by a variety of serious disadvantages. A number of 
deeply i)laced organs are not at all accessible, or only made so by the 
injuring of other almost equally important parts; most experiments are 
accompanied by disturbing eoinpHcations (hpemorrhage, pain, agitation ;) 
ex]>erimental assaults are usually much more violent and more sudden tliau 
are lesions of so-called spontaneous origin ; weak, or gradually encroach- 
ing iiTitation is not feasible in many parts. Furthermore, the experi- 
menter has to contend with peculiar difficulties in individual organs or 
systems ; in the nervous system, for example, no conclusive experiments 
can Vte made upon the higher senses, or upon the higher psychical func- 
tions ; and farther, experiment is useful only for perceiving the occurrence 
of strongly marked symptoms, for slight irritations or palsies usually escape 
observation ; and, lastly, there is a whole series of lesions which appear 
in man and in animals spontaneously, or from the opeiution of unknown 
causes, and which cannot be reproduced by experiment, such as for example, 
as the atrophy of amyloid degeneration, cancer among new-foiuiations, etc. 

In spite of these drawbacks wo owe to experimentation a series of the 
most certain and beautiful observations of general pathological interest. 
We will mention only a few, such as have benefited pathology relatively 
more than physiology. In the first place, there are a number of questions 
in aetiology to which experimentation has given exact answers. This has 
been the case with regard to the origin of most of the so-called mechanical 
and chemical, or toxic diseases, with i-egard to tlie transfer of several 
vegetable and animal parasites, particularly tieuia and trichina, with refer- 
ence to vaccination most notably, and with reijard to the inoculability of 
syphilis and tubercles. That letiology will be a true one which shall be 
based upon conclusions derived from experimental pathology, and shall 
not, as at present, consist in great part of a fruitless chaos of real and 
imaginary causes of disease. But to this end a preparatory schooling is 
necessary, which few experimenters possess, including a theoretical and 
practical knowledge of physics, chemistry, physiology, and pathology, as 
well as the spirit not to shrink from making difficult preliminary studies 
before undei-taking the solution of seemingly simple questions. 



GENERAL NOSOLOOT. 



Tliere are aI8«"> somo processes for a couipl^'to explaiiktion of wliieh 
pHtboU'gj' is iu»let»U!<l ill part tu experuticut, uml in part to obsprvntion ut 
tlie btMisitle. We will ivchII <'rily the obwirvotions upon th*' n-genoi-atiou 
■lul now foriiijition of tissunK, in jmrticiilar tlin coinmrlive, boiij', hiiiI mus- 
cular ti^«u^^s, the bIao(i-V(,*wu-ls, mid nervfs ; to the iilti?rrtlioiis in the blnoil 
during stagnation of thi' fluid witliiu the vesseU^or iu extra vasntions; to the 
ap|iejLr»noe uf hypera-'inia after A»-utinn of Lhw Kytiipnthftie ; to tht* vantinH 
iudiutidiiitioii experimeutHt the old obiter vnCiutus upon the traiiflpuivut purtA 
of aniaiidn, and the r<?<"cut ones b_v .section of cerluia nerves ; to the i-xperi- 
U)ent.!i upou the derivation of pus; tu the experiuieitta upon thnMubu.siEf, 
einl>oliiiui, and the long seri^H of ohservutioiiR upon pywiui* ; tu tixptfi'i- 
mentA demonstrating tlio uwdmnicul production of uiiiiiy dropsiett; to 
expt'rimnnU upon thooiigin of ftitvcr, IctcruB, unoiuiH, diabotes^ tubet'cu- 
loiiix, ct<r. 

J'ATtioirfjfiti.TAL Anatomy has exerted an extraonlinary influence niwa 
gfnt'ral pathology in two whvs ; by the reformation of medirine in peueral, 
BB well tm by the discovery of a niasA of peculiar hiiitologioo-}>uthologioul facts. 

The tiiftt. ]H>int, the overthrow of the ancient syniptonuitic niudicLtie by 
pathologkml nniktomy, la, in gt'n':!ral-, woll nndeittlitod. " TbH pro^reHa of 
medtcnl science Ikls bumi frnni the Hrst intiiii»tcly bound up with thi^ pro- 
gren of aimtomy," *• I'i»thnh>;»icjU anutoiuy tnust l>e considernd uh nob 
merely the foundntion of medical kuowU-dj^e, but iilsn of lht< niedicjtl art, 
BUioe itcontttitis idl timt is poHttive knowl*;tlgo in rni-dicini!, or tliii fuundtt- 
tion of 11" Piithohigituil nnnl/imy hiift newly iliflrovcn-d ii gr«it nundji-r of 
dise-tuies, wldcb hjivn symptouiii apparentty Just like tho»o of other discattes. 
This (icieucti ban uia<li5 it possible Umt our KO-caUcd phyhic-ivl diagnusti* tdioidd 
bavu reaelieil ho high ii degree of jK*rfection as it has. Such artoctimia ati 
we not deinousi ruble by means of llie Boiil[>el and microacope are, withveiy 
few exceptions, exceedingly ohxrni-e. 

The ijillnence of piiihologicul luuttomy and histology upon g«)neral pathol- 
ogy becttiue mo}fi H(i«ciidly btcurw] by mwuia of the niioroseup*', U> which 
ftlonc wc are indebted for a wholly new science, the general anatomy of the 
hi'ttlthy und di^caaL*d tusucaj of the bmly. This influence is most uppai*ent 
in thr kiiowK'dge of the causes and cioii»t:quenccs of hromorrha^, throtubo- 
sife and crntMilisni, gangrene, ilnipsv ; in the knowledge of inllammaliuu ; in 
that of atrophios and nHw-foi'uintionti. 

Pathoujuicai. (..'jiKMisTiiv liHs uot merely contributiid to our knowledge 
of numerous Hpecial diseast^s (renal Rtiei:tinnH, etc.). and of general patho- 
logical proceH«e8 (fatty and pigmentary degenerations, many tso-called dis- 
oa«ft(t of niitritiuii), but it aUo tirst euiibied us to know wt:tl the nature of 
HOTcral ditieasen, such as diabeU's niellitus. uro-'miu, gencnd fatty deyeufra- 
tlou, etc. ; and it has thus become one of the important supports of ^eneiid 
}>alliif|ngy. All great advances in the next few years luuat be looked for 
in ihifi line of investigation. 

Tb<'«o are the sources wlurncc lias conw our knowlr^dgo of general imthol- 
ogy, arid it is from thfrn that itn futtiiij development is to be derived. 
iWlMiie nhservation should be as painstaking us |ioH.Hible, and each individ- 
ual <ase sliould be investigate<l by the help of all means of exanutiation. It 
ia only too true that such <x>iup](;t4i annly^iK in [Kixslhlf! onW in well-orguu- 
ixed hoflpitulit. On the other hand, it should be bonie in mind that » ho»t 
of qneaiions are to be nolvod only in piivnto practice, an<l by tlw fandly 
phyniciiUL. Unfortunately the latter now withdmwH from the proiK-r culti- 
vation of science, and would hold the hoKpitAl physician respoHKible for 
futiuv progivsd. Experimentation ahould I'ultill tliti conditions pointed out 



8 



OESEEAL PATHOLOOT. 



above, bzkI be brougUt into use only where exact intcAtigatLon of tho poiiout 
ami J tost morUm exuuiiimtiuitK full to vli'lil tliu solution. Ltuttly, ^lliologi- 
cul uiiutuiny gluaiUl {teitoriu a double ftiiictiun \ it ftLouUl on the uito hati<l> 
and t.hut |nirffK:tly iiiilciieiiilently of motUca] olisrn'atiou, endeavor to dt:6nn 
all alu'nitioiiK of tbe organistn, with full histological luid biato-cheiuical 
dctBilH, more Hs|iecially, bowever, in tluur gnnetic mlationK, and tlieir beha- 
vior toward the orgaitizatiou in ^neriU. Ou the other liand, it should be 
cloKfly aiiited with clinical nliHf^iviLtion, iind should titudy alUT death the 
altertttioriH recognized in well-observed cases during life. I^astly, jjiiiholo 
gical chemistry idiould, in conjimction witli the ahovy incanSj particularly 
bedaide ubservutiutij becomu our tiioiit ituporLunt aid. 

At different epochs some of the oborc-namcd )iourt;o« of knowledge hjiv« hven 
espeoially cultivated. In the Xmt, t>w years thLs hns Im'i'ii Inn? of expt-rimnnfjj ]mi- 
tholo{Ey> which has been ctiittloyeil li,v afcw cxiiorlaaml Ky many incxpenenoeiJ nieu, 
Ukd which ha^ injuriuuiily Ikjcu Urouj^ht m u* coiupUctitc* ^rUiitaJ questions, oaoailif 
errota which caunot bu avoidud by ihe u»e of tiiut mtitboil nloue. 



GENERAL SYMPTOMATOLOGY AND DlAGXOSia 

Tlie pbeuometui of dL«east', those alterations in the physical, chemical, 
and Wtal attributes of the body which aie noticeable by the physician 
and the p:ilieiit, are culled, in distinctiuu from the phetionieita of healthy 
life, (iVUinuUB or shins of Uiiieuae. The kaowledgn of tlieHe sigiiK crrnKtitutot 
SKMKioLocY or SYMITOMATOLOGY. The art not merely of coticiuding from 
them to existing lucal altera tionit, but also of obtaining a knowteclge uf tbe 
oompatible and actually existing eonditioutf, or, aa ia said, the art of making 
a diugnosia, ia called diaunosis. 

In earlier timca it waa mere usnal to make a svsiPTOyATlc diao^obib; 
We were contented with the determination of tliu most striking aymptoms, 
and wv consetjueutly apokeof fevor, |>aiiL, s{>aam, dropsy, jaundice, without 
taking into cou>iiderati<iii the cau8<ia of these condttioua. Kven at the pres- 
ent day wo mu»t often remain conte-nti;*! with suob a atatenieiit. It is 
|K>ssil)le, however, in many caaea to asc^jrtain the exiateucc of defi.uita 
uUerati(>ns u|K>n which the phenomena dejKind ; thi^ cunatitutea the anatou- 

The te(p:iremGnta of a complete diagnosis include not merely the recc^- 
nitifui of the organ chietly diseased, but also that we Hhould oVttjiin u 
thorough a knowle<lge as possible of the condition of all the orgao», by an 
examinaTtnn of the {mtient. by all the means in our |>ower. 

There are a few syniptouis whose presence indicates with certainty, and 
even neceesity, the existence of certain amditiona— tbe ao^adled i'.\Tuoaxo- 
monk: svMiTOMf) ; atich ait the pulKjitiun uf tbejtigtilar vein at the haau of tlu9 
ueck, and the hepatic puliULtiun in i]ti«utTiciency of the tricnapid valvea, the 
rust-colured aputa in pneumonia. Such symptoma are howuvcr few, and 
their number haK diminished more and more with the gixiwth of pathulogical 
knowledge^ Nearly ulwaya wn caunot conelu<le fn>in a atngh* HViiiptuni to 
the exiatenco of a gi* en morbid atate ; we nmat conside4' a nu mber uf syiojv 
toimi together. 

The term neoatively rATiiooxoMOKio 8Vmptom8 may bo given to auoh 
OH do not at all, or haixtiy ever uccur in certain diKetiacs — as Imrftts laJbialia 
in. typhoid fever, many tcm|)eratutv changed in various diseasea. 

Symptoms ai'e commonly divided into direct and ini>ihe<.t. The direct 
are auch aa depend Luuue4iiLlely fi-om the altered urgau, auch aa^ for example. 



OKMEKAL ^KUKIOLOQT. 



9 



the color aud other pcculiarilies uf the skin, tho volume of oipiiis, Iheir 
barduess ur softuess, unevenut^ss or KtnoolhnesD. IiiJirect syuiptonis fti'o 
the oonsvquences of certuin hIaI^s of nrgiina, whose direct (^xumiualiou is not 
liniclicable. Tbu piilae l>eluiigK to tliU clittw in that iL ttouiPtiuiea iiidirutes 
diiicaAe of th*) liititrtiuid artocieK, or iiiovhid stilted of other oi-gana. Many 
alterutioiiB of the uriuc aiid sweat bflong to the cIuab uf iudircut ctyniiitouin, ha 
in hepKtic and cortbral dist'iises ; some disordera of the stuiimch oro indirect 
svinptDtna uf reuul dtKeUMe, L'(l*. 

Be^^f^. we Mpante fnnctiunal from ttuticat iijrmptoniit. Functional or aocive 
f^iuptotUT) give iiifuriuatjou TCH|icctiui; the dt^ifree lutd luojti ut a<:tivit,v oT Qr^asut. aa 
tnnvfuit'iitn, MJUMiiiuiis; as, for tixiiiii|il(*, ilyH|inti.>n, pain in Llit< L'heAt lU tlii>niciu did' 
AA>w«L I'luviTK til* ttULliu/il Hyin{iU»ii)« iitiliuulu only curbiiu liH.'alizui] cunditionn of 
t oigaua, UM ohaiisea in the form of the ibumx, and alteratiuos in the Btruotuio and 
texture uf porta. 

Furthvrmuri*. KytDplouui nru di^hi^nl^id pcniAtKnt wlitm thry orcur tiimagboat 
a dieeasc ; and iuLorciureul wLuu th«y ahow theuittclvts fiom tioiu to time. 



Very inipirtuiil is tlie diKiini'tiuti between ORiEcrrvE and 81^bjb<tivk 
SYMrToii€i. By tilt) teruj subjective Kyniptoms, we unthn-vtand such ots tliet 
ftalirut himuelf ft-els, us paiii, a seiise of |ni»i«urr, of cousinction, etc. Thnj 
ftre modified iu the most varied way by tho ]>eculiAritiett of putient^. They 
are more prominent in young mxl immpered individuals, whereas many 
Beveio disi-asea in oM age arm ili8tin;(iiiHht,'d by tho aburnco of llieae ni^iiii. 
In tiiis clfljifl, ilio first nink is neonpied by tin:! syinptom of pain, i.e.^ abnor- 
mal irritation, or abnorniully inerftiaod activity of aensitive norvee. 

Objective 3yni[)toma are such as the physician can observe and uppreriate 

thron^dt IiIh sctiHes. To tlii« end wc u*w the eyp, itisjwcting din-rtly an in 

, caac3 of duH>iise of thi* skin antt acceHsible iiiui;ous meinbruiKts ; or with tho 

'lielp of illuDtination, as with tliu uphthiilnio.sropc, laryni;nM?ofie, Bpecula, 

etc. Koiutdinii'M we eni^iloy the ear. as in studying tb'? pheiin»u*nu td' \u^r- 

OUKKion and iti^u'tillalion ; lit othom tlie Lift, in order to ascertain ibecbangea 

Ui ibc cunaisiency of parts, for tho study of tumors, of puUe-cban^ea, to ex- 

Bmine the vagina, rectum, etc. To tluK cate^vory we tuuHt also add all the 

i resnita obtained by meaauremeut, weighing, by the thermometer, by micro- 

ftCCHtioal and chemical examinauon, Ate. 

Tbe value of various i^inptoius in the critical appreciation of a caAA ia of 
course very different. In gi*neral the value of a sign di'jM'iids upon the 
cleameaa and cui'tninty with which it ciui be maile out, and also upon the 
degree of certainty with wbicli ita jiroductinn wm Iw trace*! Ui a partieular 
organ. In eonae(|muiceof the git-ater dt^-ee of positivetu'S.s llii-y Ijiiii;; witli 
thom, objective Kyntptomst are of much grtMtiM- value than tbe subjective. 

Among ohJHotivu signa thfre are Konie which are bvf'U^bt to light by 
|diy»i<'»l, chi-miiid, or ndcrQ>tcopti-al nii.'tIiodaof invei^tigatiuii, and winch are 
peculiarly rcliabto and valuable. The moat objeetivo, and lx>tter named 
moat t'UVaicAL hymitoms,* are such as uro not merely obs''r\'od by mi>»na uf 
Lu»trumenta, but which are in tbem^dvea nieaaures of the amount of the 
phfn'iiiieua. To tliia claaa l)eloiij;n ihermometry ; for, whilo the estimaiion 
of skin beat by tbe hand is in the higlu^at di-greo falla-'ions, by tlio correct 
applir.kt.iun of the thennomnfer we not only obtain the exjict tem|KTature 
Uh a fuct, but we alati iJiereby obtain a niRiiaure in ilitgrees of the atnount of 
fuver pre.sent. On the olbt-r hantl, it ia a niiauue of thi" lorni phyaicul if wo 
Speak of auscultation and perctwsiyji as "physical diagnoshj;'" becauau mncL 
more depemls uiKm the experience ))f tlie obBerver and the dexterity of bia 
bauds in j>ercwuioa than upon accuracy of bearing; uid wo poasesa no 



10 GENEHAL SEMEIOLOGT. 

objective meaBure for the phenomena, such as, for example, clear and dull 
sounds. 

In order correctly to appreciate phenomena, even the objective, we not only need 
a knowledge of anatomy and physiology, of pathological anatomy, pathology, etc. , 
but also Riwcial preparation and experience. Above ail, we must know what to look 
for, what to obsen-e, and we mu5!t also be expert in those methods by which the 
phenomena are noted at the bedside. The physician of to-day must possess more 
than ineie technical knowledge, he must have that skill which is only to be acquired 
by instruction and industrious practice (Wunderlich). 

Latest diseases are such as remain wholly or partially concealed fi-om 
the physician in all or many cases, at their begiimiug or during their whole 
duration. This is either because the organs, with which tbey are connected, 
are inaccessible to examination (many ptirts of the lungs, the liver, ]>anci'eaB, 
etc.), or because the functions of the parts are not known (certain brain 
regions), or because the disea.se is very much restricted (many pulmonary in- 
flammations, cancer of internal organs), or because they are developed slowly 
and the physical proi»erties and the functions of the organ are not percepti- 
bly nioditied. Many diseases, serious in themselves, remain latent, Ijecause, 
as a consequence of their existence, compensatory conditions are developed, in 
conaeqtience of which they (the diseases) remain without symptoms ; for 
example, hypertrophy of muscular organs behind narrow places, as at the 
cardiac orifices, the digestive apparatus, the urethra, in collateral circula- 
tion, etc. 

The subjective symptoms of severe disease of an organ not seldom remain latent, 
if another oi^an be equally or more severely affected ; as, for instance, the symptoms 
of pulmonary tuberculosis in cases of extreme tuberculosis of the larynx or intestines. 

Very often the phenomena lead us to suppose that there is disease of a 
part, without being sufficient to enable us to determine the nature of the 
disease. 

The concealment of a disease is often only relative. For in the majority 
of cases the symptoms can only be discovered by peculiar metliods of 
investigation and by modes of reasoning, it follows that their discovery will 
depend upon the individual degree of skill, knowledge, and the faculty of 
judgment of the investigator. 

The further subdivision of symptoms into primary and secondary, essential and 
accidental, consensual or e^mpathetic, local and general, is in part self-evident and in 
part worthless. 

There are three ways to arrive at a diagnostic judgment. These are of 
diiferent degrees of value and certainty. If we wish to proceed safely we 
must not foUow^ the first and second ways alone. 

The fihst jiethod is diagnosis at a distance, the becognitiok of the 
DISEASE at a fikst GLANCE. In uiany diseases of the skin, of the mouth, 
and j)harynx, of the joints, a single inspection is suflScient. In other dis- 
eases, however, to content one's Sflf with such an examination would prove 
most superficial, and would often lead into error. In this connection we 
should take note of the general impression made upon us by the patient ; 
and this becomes more instructive for the physician the more he has the 
halnt of quickly analyzing a patient's general appeai-ance. Even if we 
cannot, iu this manner, recognize the disease itself, we may often obtain 
information of use in determining the location, degree of severity, and 
danger of the disease. We use the same procedure in daily life. If we 



DIAO^OSIS. 



11 



meet h stranger, we oonelude fi-om physiognomy, the cxprf^sfiion of Ljr pyes, 
bin gi^tiin>K, liis clrpartuient, fruiii the firHt impre&sion we have of the 
dvvelupmeuc of ccrUiin parts of liis biidy, to iiici inner psydiicnl life, his 
character, bi» education, oci'upHtion, Inn iiiliug 'uIhaa nnil purMtiitH. In the 
eaiue w»_v the f.x\*f3rt can, from the t-olur uf tht- inca, from tl»i' i'nciai i-xpreis- 
sion. ilic po8tui*e, mode of lying, the walk of the pntinnt, from his nmnner 
of breathing, of speaking, etc., often draw a]»po)Ut« couolusious as la the 
nnliire of the* diseKmi. 

Tub SEi-OND WAV TI» FOHM a DIAOVOSIS i-OSSTITUTES IHA41NOSIH rttoM TUB 

AXAUxesis, tliiU is, fruni thi' story which the patient t^lls of hi» illness. This 
account tiauaUy ot>n«i»lA only of a ii.fciLal of sensations of the moat varic<l 
kind, tiiii*rmiiigl>H| with oonjeeiiires upon the origin of the di&CHiu;. If tho 
patient bo competent ti) give a eh ro no logical account of the cour»o of his 
aJluieiit, it ia sometiiueu poKsihle to draw some concliiHions from tlie oflflii 
coufuseil story as to the condition of tlia putieat'a body. It is necensary to 
uudcr»taud [>opuhir expreKKionH in order to bo ublo to tiunahitc their vogue 
import into medi<^l liingu»ge. The phyHicitui in HOtuetimea obliged to give 
ad^ieM tit and tmat patienta at a diatance u|ion siioli KOurcfVH of Inforntaiion 
tnmsmitled by Uittttr, H ia wrll always to do thin with the greatest 
caution, fur it is natural that inoumploiA obsorvatiou should k^od our juUg- 
mnnt into error. 

The tiiikd asb si-rest ©lAosoarrc pRm-Ess is the oBJEtTi\'E iNVEsrmA- 
TIOX. \Vo in this way stNik to convince onrsrlves by actual senaorial 
. observation of the anomalies presented by the dwmsed orgHuisin. In order 
' to arrive nt tlm most [KMiitive and compreocnaive jntlgm»'nt of the eomliiionj 
it in not suffirient to invL-^tigato that part nf whieh the patient complains, 
but we must iii>^uire into the state of ev(rry part of the body, and the eou- 
ditiou of every function. Thia Ia«t rule ix e8>*ential if one means to proceed 
in a well-grounded and certain manner. The phyaieian's art consists mainly 
in the thoroughness of bia examination. Without this, in spite of thorough 
Bcientitic acquirements, he remains pnuilicaljy a uselesa man. 

TUK HX-VMIViTtflN- OP PATtF.STS ConKlHta (if tWO part.H, 

Tbu tivsi is devoted to the obtaining of the AK.i)iNEBis (or HiftTortv or THS 
case). The coDver»ation is most pro[ierly begun by a geuerid im^uiry, 
Wliiu do you complain of, where ia your trouble? Then the |Mitient injty 
he allowed l-o talk unint«iTnpte<lty fur awhile, but, aa aocui aa he wunilfrs 
off to irreloviint niatier^, aa he connnonly soon does, then it is neceasary to 
aak H|M*rial queatioiia. In order to reach a c">nelm*\on in ns abort a time as 
pOHsiblf, and to danionatriito our inlemst in the patient*>t condition, we tirst 
inveittignt*? the organ or function which he l»iOiivea to be in a morbid atate. 
For example, if the patient cotnplain of chest symptoms, wo ai'e to pro- 
ceed at once in this direction. The imporUnt pointJ* in this connection 
ftre : Cough^ liow much, at what time of the day ; if rhn>nic, whether il bo 
RHually present, or at time^ altogether wanting; — Ex[iectoi-ation. ila loone* 
. OeRfi, (piantity, and color ; — Dy-^pniCA, whether when ut x-est, or excited by 
ImoTument ; — I'ain, dull or wharp ; its seat, whether in the centre or aide of 
|«ho4t;— the mode of lying, wh'-tlier upon the right or left aide, or if poa- 
r*ib]n on both aid*?*. And for the larynx, hoai-aoness, etc ; for tho noae, 
ble*>diiig, Mle, 

In an analogous way tho phyaicinn should investigate the condition of 
the dtgi'itive organs, the urinary apparatus, etc., and inquii*e into altera- 
tion'* <(f nutrition, into the presence or absence of fevei*. 

If we wiah to make a more a[>ecial inquiry, it Ixtcomea neoesaary to asoer- 
tatn exactly the duration and course of eac!i individual symptom, and, ebpe* 



13 



FJCAMiMATIOK Or PATIENTS, 



ciuUy in chronic disejises, to ileierinine all the circumstances wliicb bttve 
causfHl iiii])roveiiient, or wlui'ti liuvc; miulc i)w dist-flse worse. 

(jiit;«tiori*( uoucc ruing th<.' name, iigt*, hihI condition of the |mtient, which 
iiHttallj in hospitHlii |it'ui*>.'<d(! tliu fxiLiiiiiintiuti nf the piitiuiit, Nhoitld iit pri- 
vate pmetioi bfl Asked at the elosu of tho exutiiiiiutiuii. or eiuiiully dtiriuj* 
ii. Inquiries into the causes of disease In genei-u), into the hvtillh of 
parents, gratid'iiMreut4, siatt-rs and brotherx, into tht- dwrlUii^iC} victimis, 
cIothin>;, hahiih (a8, for ixainple, indnlgt-nee in idcaholic drinkfl, in ATiinking, 
exercise, sexual intorcourae, into previous iliseasns, csiiecittlly syiihilis), 
ill the utse of young children, into the inotk' of feeding, ipto teething;, may 
iit Niuny aiK4'»( he wholly oiuitterl ; otht^i'wixu they are lukL-d ineidentii [Iv- 
or at the end of the exHminalion. No very exuct rules cau \k: glvon in 
this coniieetion ; muuy of the physictuirs qupstious lip^rear to the putiettt to 
be proiuptod by mere cmnosity, uniniptHHiit ones as vei-y newssary, etc. 

In the case of unconBCtoui* or irre*.|KjnsibIe patiouta, or of yoniijif chil- 
dren, vre must obtain the anfimiiesis from the persons oround the piiiient^ 

Tlie Ki'coud [Wirt' uf tlie exHniin:U.iuu ivhimsU) in the study of the premut 
condition of the patient, the utatun piivjnms. 

It is bi*flt to proceed in a systematic way to examine the various or^^nns, 
in order to overlook nothing of ini[>ortunce. It \n well to begin with on 
examination uf the nutrition of the wliolt! body, color, etc., of the skin. 
Then the tem^jeraturo should, if required, be measured by meauti of the 
thermometer. 

After this we proceed to the examination of special paila of the body, 
beginning with those -which are most involved in the disease, or whose dia- 
i>aaes are most important; the head (th^ mouth aud pharynx inelunive), 
neck, cheat^ abdomen (also the gchital organs), the extremities. The 
examimitiou should conclude with n ntudy of the seoi-elioua and cxorrtioUB. 
jf the above prncodunt has i»een enacMy carried out. ii. is ipiiu^ |Kts«iib|ef 
iri the pn^w^nt Htjite of onr knowlrdge, to form aii H)i|truxiiualely exnct notion 
pf the coudition of the patiences orgiuiK, in niosi cases of chnmic disease, 
and developed acute diseases, Next to the exactitude of the investigation, 
its mimy-sidetlnesij should be urged. 

The art of lUagnosis is only to Im' lejirnrjd by long prnctiee at the bwl-side. 
In genenl terms, the pi-ocows of drawing the mast correct crincluMoii as to 
tho c<»nditioti of organs from the mat't'irials amassed in the exMUiinulion, ta 
the following: We I'ecapitulat^ to ouifielves in a brief way the most im- 
portant alterations of organs which we have found ; we try Ut recognize 
ut ih'om gixjups of Alterations a resemblance to well-known |Mithologicul 
conditions. If such a resemblance ia not reatiity made out. we |iroof<e4l by 
wliat is called the method by exclusion ; that is to say, wo review in onr 
minds all the diseases which these organs may suffer from, and judge 
whether any of them eiiiltnicn the Kympt4>nis we have olwervefl. In this 
way we reach the conclusion that in all pnd^ability tht' group uf itynipt^mi^ 
we have observed constitutra a certain disease, or is one of sevend. We 
must not, allow ourselveK to be influenced by the pn-sonco of a prominent 
symptom, for thts ntiiy not alwayn be chuhikI by one lUsoaM.' (.is the hroncliinl 
breathing of pneumonia), but we shouhl weigh well all the |Hiasiblp olukcs 
of the soniirl, and conclude that there is pneumonia only when all tho other 
symptoms and the coui*se of tho iliBP-ose concur to prove it. 

Kxperieiiec* t^rachett that certain couditiouN and morliiil procd-vses usiihIIv 
exclude? one anotlier. Thus iu cases of tubt^rculjsia we liehlom encounter 
haart-discjuie; and whoever luis a developed morbid state of the heart haa 
altuotit ooquii-ed au immunity from tubt^rcutosia. lu the some way tuber* 



PBAONOBIS. 



13 



ctlloffis and cancor liartUy evof coiuci'le in one iitdtvirliml. In cnscs of 
fttro I) ^ly- marker) dfforraity of the tborax (MColiottU and kyphosiM) tiilit^rculosis 
tmrdly nvcr niAkos it^ nppoaratice. Among acute; t1Ik<>uncs, typhuid fuver in 
llie ono ni'-vsl oflnii exchulei) by otlitu* conditions : it si'Iilom utUick-t piegniint 
and recfiitly ddivccotl wuiueii, «nd almost never llio»e wliu have ucnt« 
rhenniiitism oi- iubL'rculosi5i. JJetpfji labiulU is vnry r&re in Lvpliuid-ferer 
|Mitientfi. 

Other morbid processes are oflen conjoined. Tubercnloma is nlways 
uiiilei] with ItrimchitiM; gu.<ttric catan-h witli nearly all HHvore uculc and 
chronic disorders; lutrjit-s hthiaSta uften coexiats with intunnilli^nt fevur 
and pnennionia ; Rcute rheumatism ttud heart-disejute arc not rAi*ely con* 
joiiii'd, i»t*T. 

An in indiridnal-i, cx'rtain f<>nn.H tif disciise combine n[>on a large ficalo in 
certaiu periodH of lime. Whooping-oou^jh and mt^asU'S, acarlot and typhoid 
fevLTi^ scarlet fever and angina, intcrniittout fevor aud dysentery often 
occur contem[>onineously. 

an?fERAL PROGNOSIS. 

In pnotice there \b oonjoined to diugnosia what wo call pttocKOsiB, or tlio 
forvtelh'oKof the contHU, MODincATio.Ng, and tehmination of the diHeasR. 
Id this conneetiun also there is little to W snid in a general wuv. The 
very firwt impiiry usually is, whether the (lisCiiHo will terniiiiat<- favumlily or 
unfavorMhIy, or whetlii^ the issue is doubtful : profinoni^ /amtUi, infat/ata^ 
nncf.pa. The next peintB are, if life be not in immediate dani;er, will the 
rmtoration bt* cumph'U^; anil liist^ how long will the diwaae lant. 

Nstunilly these qnestion.s munt be exainined in a inorw »pepial way; for 
euraple, when the pro^osis is unfavorable it shonld be delermined wiiotlicr 
m chronic tliseajie, a aecondary affection, or death is to be exprctyj, 

We call fiEV'EHR DiHEAHRR Riirli OH threiileii permanent injury to im- 
portant (U'gans, or dt^th to the puttnnt ; Mii.n i>ikrasbr, tho»e in which, 
andirr ordinary cirL-umsturnx'S, a iioiupleU' cun- is to ]irliM(ki!d fi>r. l^Exior* 
DI.«K\sHs arc thftsi: in which the tippn-ciablt- group of phenomena indicates a 
stirt'lr fivorabjf issue; MAi.iov.^ST dwntxHca are those into the course of 
whicl) niiri>res><eii complicMtioiiK (?ii.sily LMit4'r. hb Hcarlet fever. 

The aiiAWom to ihesi* profjnostio f|nestiuns are to be shaped upon the par- 
ticiptttiuu of the geueraJ organism (fevor, state of streugth, etc.), upon the 
extenKiou of the dLsease in the budy^ upon the value of the afl'ucted u[*gan 
for the ruiunlenanee of life, U|H>n the |«itient'» age, upon the vigor of hin 
Donstilution, upon thn chui-HCter of au epidemic, upon the possibility of 
employing the proper remediea, ete. 

The correctnesa of the prognosifi depends mainly upon the exactnesa of 
the diagnosis. If it be in a measure true tliat at the present time minute- 
iweM in iliagniwia is carried farther than is neeeaaary for therapeutics, it is 
not At all 80 for proii^KmH. For, he who has an obftcui^ view of the condi- 
Ikni of a juitifMil will bo surprised by many variatiuns in the course of the 
diMMtf, wLiuh abetber-driJled pUysiciun would foresee, 



DTTllATION OF DISEASES. 



The duration of diitcjises i» exceedingly variouK. Many end in a t<udden 

OHtAstrophe. liLsting one or a few miunteH ; mimy olhi^i*s last lioiA a and days, 

any weeks and ninntlm, some during a lifdiuie. T)iaenae44 which lafit but 

k short lime are callml AcirrE ; tho.-t<i which la-^t a long time, rnitOMC (Ua- 

%\ and some ^mss from tjio acute into the chronic stage. 



14 OOCRSE OF DISEASE. 

At the present time a olassiGoation is made rather npon the basis of the nraal dnra- 
tion oE individua] diaeasea, as, for instance, in the cose of phthisia and rachitis, which 
usually last for years. The term acute is applied when these diseases run their 
course in a few months. Typhoid fever in spokeu of as an acute disease, although in 
maDy cu&es cure is postponed beyond tbe fortieth day. 

Acute diseases not seldom end in chronic states, and chronic diseases sometimes 
terminate in an acute manner. 

Synonymously with acute and chronic, we often hear the expressions febrile and 
KON-PEBlitLK DlsEABRS. This is true of a good many cases, though many acute dia- 
eases arc non-febrile, many chronic diseases febrile, especially in their later stages, 
many affections arc at various times febrile or nuu-febrile (catarrh, syphilitic, or more 
seldom other cutaneous diseases). Many non-febrile diseases either disappear quickly 
or kill suddenly (cases of poisoning, haemorrhage). 

Fmally we have the terms typical and NON-TTncAL, used together with acute and 
chronic, such as exhibit a regular course, measurable succession of stages, and those 
with a variable, indefinite coarse, without a distinct tendency to core or death. 

The duration of diseases depends in a general way upon the causes. If 
the causes have acted in a tran.sitory manner, the duration of the morbid pi*o- 
cesses is short. If the causes are connected with circumstances not easily 
altered, as mode of life, habitation, occupation, the disease is apt to last 
longer. If the active agents are poisons which have been absorbed in small 
quantities during long periods of time, a prolonged languishing statt: is 
threatened. 

It is also to be observed that the more localizations a disease has, the 
longer it will last. 

Besides, the length of a disease' depends upon the nature of the altera- 
tions which accompany it. The majoiity of disorders of circulation, and 
inflammations, run in general an acute course. The more diseases vary 
from tliese ty])es, and are accompanied by metamorphosis of tissues (fatty, 
amyloid degenerations) and uew-formations proper, the more their course 
is, in general, chronic. 

Lastly, in some tissues, as in bones, all diseases last a long time, because 
of peculiarities in modes of nutKtiou. 

COURSE OF DISEASES. 

Every disease nms a defined course. The changes in the circulation and 
nutrition, the functional disturbances, which appear from the beginning of 
an afTuction to its termination in a return to tlie normal state, or the death 
of a part or the whole of the organism, are limited in dui'ation. 

Occiisiomilly the alterations subside very rapidly, in a few minutes or hours. 
This is t's]tecially likely to occur when we have to deal with the so-called func- 
tional disordei-s, or with variations in the blood-supply of single organs, and 
also in cases where only a small amount of organic change has occurred : as, 
for exani])k!, in anaemia of the brain (the usual cause of vertigo), in liyperajmia 
of the brain, of the skin, lungs, and other organs, in many forms of spasms, 
in attiicks of pain, as well as iu many febrile states {febricula^ ov febris ephe^- 
•mera) ; a stationary condition, in which the phenomena remain the same for 
long periods of time, without increase or decrease, is not met with in strictly 
speaking morbid processes, bvit in the so-called morbid states (monstrosities, 
defects, etc.), as, for example, in many paralyses, certain muscular hypertro- 
phies, encapaulated parasites, scars, pigmentary deposits, etc. 

The majority of diseases run a definite and generally easily traced 
course, which is either regular or irregular. 

A REOULAB COURSE, extending over days and weeks, is met with in. 
numerous surgical and internal diseases, in the apyretic as well as iu the 



COURSB OP PISKAgK. 



15 



PJTrtic, Braiilrs, among (Jifsc are somo wliidi exliiMt jicruxlH rt^iliirly 
EuccvtMliug r.||i> tiiiothci', each ptriod liiiving jH^cutiar chiimctoiti, tlio »<>-tiHl]«<l 
TYPU AL ur imvTiisirrAL (cycliii*! or i»rii»tilicj liutCHses, such as inaajr 
apvi-viif nirvvtiotj* (fieurftljiia^ liH'rn.ni-lia;5«', fi'^*'t» elc), imd also, and 
e?<|irciHlly. f^-riitiii pyiviic (iiju'suipji (ty|>lius hidI tyiilioiil fp.vors, tTlA]isiiip fever, 
sfuall-poj(, mt-afiks, scarhitina, cotiimou pnetiinonin, fL't'tTit- tntcrinitteiit 
fever). Otiirr diseobea arc only n|'pioxiiiintivi'ly typical, (li«t ut to aay, 
their cour^i* is on thf whult- not vi-iy icgiilar, or only so dmiiij' a |Hirt of 
their (lunitic>ii, a» in luaiiy Apyi-otiL- cdtaiTluil di»itiiHt.>H, rhL'iiinatiKiii, i;out, 
bat jHirticultirly febrile allL-ctioua utnt «» maiiy urut-t.' catinrliN ttmtiilliMs, 
ftt-iiU^ ariiriiliir rhfiimAtisnt, nieninuitis. pyiiMiiia, erysijM'lan, t-'U*. 'nmrn ar© 
ji*l otlitT iiiv.'ahi*H whir>|i lire nfiniy|iirnlr that ia tu nay thpy nxliiltit ihiring 
thoir cotinif* * typi' whh'h vai'i<r« acconliiijj tu tho ai'vei-ity i>f tin* attack, 
whil«i thu Oilnilo niauifcstatiutiH show no i-(>{;iiUirity, or ai'o altu;;i->ther waiiU 
ing, aa in niatiy c'nM--s of stipjHiratioii, iii)himiuaUoas of llic t»ui'oua mcm< 
bnuu^ iU|i))tliertii, tlyiiotiN^ryt phtliinta. 

In typical ami almost typical iliswiscs we not rarely raewt with irr«'fi;ttlar- 
itim, oi <leviaiiona from the n-qiilnr ct^nrsu. IIi&hq d<<pt*TKl iijiou Ktiologicalf 
iutliviilual, ••kU-t»u1, acciilaiilalf or llicntpi-ntical inHu^ncca. 

Ill iliaeuBca luiviug a ilornliuK of hcvuiuI days, be tlicy rfgiilar or not in 
their cotirdt.', the onH«;t is of(-eii nio&t various. Not rarely mi indiiidital, 
hitlirrio iterffctly .well, is tnuhleuly j»liirit;vd into a sevurv curnpU'xily of 
syuipf^iiiM, u» liapp^-nH in vhmvs of wmni'ling aikI toariii{( of intcrnul nud 
pjtternrti pai-ts, in wrtain spaflntudii* «*n<-ctioiiR (e|iilepRy), miniy intoxicntiona 
(by nctf)?t, phosphorus), and infections (bcarlut f<-ver, aiuaM pox), all folirUti 
(Ibu-n»e!i whicli bogin with a chill (pueunionia, toustlUlia, ititoruittcnt 
fevrr, etc.). 

Ill the majority of rjuiP-s, howevei-, tlie iliseaso bepns moro or less inKitJl- 
ouidy, ami ile tlevulnpmcnt is not noticed by the patient. To this cah-gory 
WU'tig tile majority of non-ffhrih^ diKeiLSr>}(, an<l also many febrilu aU'eclioiia 
of tb« uiiifous an<! Hcroua nionibrani'K, such a* nitnrrha, pleiiri^iieR, rhemna- 
timn. The phyaiciiLu finds the greater diflictitty iu corrt'ctly appreciating 
tJiewi cnws, becaujw tlw phenomena of onset a»-e in gi^at part or wholly 
ohsciti'c. 'Hiciy roiniist naunlty in g<*neial mnlnUe^ prnalnition, n^tlrasneas, 
loss of appetite, fJcepIi-Hsncsj', Rhi:>oti))^ paina in various pni-ts of the l»ody. 
In »on»«* case*, even after the niosL exact ohaervation, the phyMcinu finda 
nothing di'tiiiilr: on the fii>t an<i sik-oikI days. Thene iiiantfeHt^tioii.'i, even 
ill vma^-i in which the priiu-ipid morbid proci.-sH exhibits it^^elf itt othtT pnrU 
(aa in llie aictn in the acute exantheius}, aru dcisigiuitetl a.s thn f<>renmuei-a, 
or rKODttnUATA of the diseiuo; and the time dunug which they are observed 
is termed the Htmlivm pnxirumorum^ ur the ])renionitory atagt;. 

l^tm* on in the eoiinut of the diMnme the various jihenoiiiena tncreaiv in 
int^nnity, or new ouea appear. TJie coui-sc of a diaeiuie but rari>ly pr«x'e*'d» 
uniformly forwanl and buc-kward in htated iferioda of time. This i« only 
true of ot^rtAin fehiile afleeiioiiR, especially the aciit<» cxaiitht^inatn (small- 
pox, acarlet fever, nieaalea), iu a few othi^r iiifeotioua diseases (typlma and 
typh<>id fevers, relapsing fever, pynemin), in a few internal inflainmations 
(cniiiniDit priuini-y pneumonia., tonsil litiit, cerebral meningitis), in inUtrniit* 
tent furur; not at all in chronic disf^aties, consequently we define a number 
of ao-calird stagea : 

Tub btaoe or increase, or of imvasiu.n (utaeJium incrrmmti), which 
in febrile ili«teaseA is also termed the pvitooESETro stace. 

Tua STACK or uinnesT intensity (utmlitunacttKs^atu ttanot), in fehrile 
dJjwiMwi known also as the J^tutifftuM. 



TirE STAOK OF DRrti£ASE (fitarlittm Jrcrfinif!nti)y which in fohrile Hiscnsea 
(ittheiiineof pnigiTea^ive diaiinuttou of tt'mperiitHrBisc{ilIe<J dekkiives* enck, 
ftiul limy talcH the ^hupe nf i-'iiisi)>, or i.YHis. 

B<:tAvt>eit tho Kia|;«?s of liighitftl int<>iiKity onil decrease, in many diM^mAPS, 
purticuUirly m suven; pases of typhoid fever, puHumumiL, ucutti exontUe- 
inata, etc., wf meet witli tin iiit*tr mediate fltAgtf, or STAflE op [NT>i£f'I8iON, 
whieli D* teritUHl fitiuiinm amphi^MAfJi. 

By the tn-ins ihisis, or iiEsou'Tiox, we undcrstjind im improvpturat 

which takua pUw Buddfuly, iii ft fyw (4-24-36) hours, hdJ which Ib hccoeD' 

jwnied hy a sudiWii fall of tempcrutiire (fix>iii 2" to Ti" G.)t h-uJ '» puliw;- 

^^ratn (frnm 20 Uy tlO heatJi), and also by th** of^iiiTf-ncr nf hwvatinj*, Kl(*p, 

^v urinary dcposit-s, etc. This is strikiugly stron in relapsing fever, croupous 

pnoumoiiii), mnu<le<t, etc., and iu intermitteut fever. 

Iliuiiierliati'ly jirewding the iinpnjvetneut tliere not seldom taken plai^, in 
muiy diHeiist\4, a nliurt increuAe la tlie gravity of the syin|>toius, the Au-called 
pe-rturbatiti critir.a. 
SI 
c 



I 



Fonnf>rly under the name of rnt»i8 wunDderatood the termination of a disease 1)]r 
liho exun-'Liori of imiriiid iirwlucts, and their Rxpulnioo from Uie body. To illustmte, 
it wa« Llintiirlit thai the upiiuity nf Mie. iiritx'. {inxlu'od ti; nii exceaa of urate of wmUi 
(nut a rare occnin-nw at the rriRi^ tiroei. r^priwiiu-tl tlie rxpelling from tho IkjHj of 
a Bubntance pr«liic»>d Kj* the diAenpe, Ihe [icc-rnnt matfirinl. Tliif« notion in in a 
meaaiiro not whutlv wronj;, m wo to-tiay admit iIjM there ar* in the wrcrtrtlons mib- 
ctuuecs produced by dcrnn^^ iiiotatiior|)bo«u) during lbr< difleaae ; bnt we believe that 
ihCBc ptoducUi are the rL»iill!i, unt thu caiisun ot tbo diiwaBe ; and Lbnt the tnorliid 
coailitioii do«fl nul cbaho becauHO tbt>HU ar*» eimretcd, bat that the HtibHU-mces are 
throicD oni when t)io local dtneitre impnit-CH. In a wonl, wti to>day emph^y tbi) word 
CTUfin ratbpr in a xymptomatologiuoJ way. an lui ftxpromioD for certain appcaranceji, 
Hot in an eiq>Ianatory ftense. 

AV'e H]ii>ak of Lvsis, or solution of the disease, if the im^'roveraent (fulling 
iou)[K>niture and ilitititiishin^ pnlse-nttr| IusIh longET thnn two lUiys, and 
yet JH completed rapitlly anil jiernmiiently. Tim ia ol>Hervpd in typhoid 
fever, swirlet fever, many catarrhal nffcctionB, etc. OcujisioniiltTj aA:er all 
thoHe Jitjiges have hewn gonu through, the samo morbid conditiouB up|»ear 
afresh. At an early Mage this retiiin of.diiwaso ia called iiELArsi::, if it take 
place as a part of the disease, a pheuoineiion of ita noniiii] eourso (oa in 

I relapsing fever) ; if not, it receives the appellation of uKti'KRESLE. In a 
Incurrence of a diwaR*; it is [Kusible that not only tho jiart pi-evitiusly 
iftfTect/'d be attAcked anew, but other parta of the same tissues or organs aa 
■well, as, for exftm)de, in eryitipelas, pneumonia, typhoid fevor, pleuriay. 
The laity ore also in the habit of using the woiths recurpeuco aaid reliqxie, 
a.<t meniiint; coiTipli<-uli<ui3 arising out of the original dia'-ase, 
All dist'asrs do not, however, pxhihit an uniform and wtatrd increase and 
decrease of symptoms- Their course shows fluctuations, and even interrup- 
tlon». TlicK fluctuations, if they indicate an improvement, arc called itKHis* 
BIOXA, anil if they coti.Hifit in an aggiavntitm of tliH KViuptoma, RXArKKSA- 
Tross. 'Jliese phiwet* are met with in many iioii-febKle, acute, tutd ehronio 
diaeaAes, ami in some febrile atfi-ctiona (many chronic exanthemata, rheii- 
matiRm. catarrhs, etc.). Attacks of illncsa niiii-h n'tnrn from time to time, 
alhiwin:; contplettt iutHrva!» of health, are enllw] {ieriitdical (aa, for example, 
^^ itit^Tiuii tont fever, epilepsy, nervous asthma, hiryngi'mu* itruinhni, whoo|»- 
^Ting cough). The period in which the symptoms muku thi^ir appeaiimce ia 
calknJ the i'aroxY^M, or attack ; the tionnal interval] if in a febrile diaease^ 
is denomiiiiited aitkuxia, or non-febrile |>nriod. 

^f TitE iKTKiturrTBNT TYPE in aometimos regular and fixed, that Is to say, the por- 
ozjBDU return logularly at tbit same hour every day (aa in intermittent fevor>; 




^Ib 



TVPKS OF FKVfUl, 



17 



aniJ cliangpfllile . Tho Intit*r mny outmr in twi> modps, 
■ the piutntyxm occiirs ench time one or more lioiim earlier tUau tho iireoudlMg- 
Pi llio ',: — ■ ' ■•'ni'/tiii* irilrif'iicn^ \ta at tbe bL-jjiutiiubf of iuhirm'tUiut feverl, 
or it uuik' .rojioe IuUt vuch liiuo, tjfput intermitteM fiatjiongns [nn tuniu'j 

Un! «u"l »•: ' lit fcvu-r). 

In tntenniLtcut f<;vcr Ui>Te i» nlwajn n i^giilKr rliyt.htn, inuUiJiii];; prriodx of oti^ or 

xtioro dajf, an<l wblcli w jrhortcned on eatrh tiny only liy a f>'w boiint nt tho farth^at. 

If tho attflck of fcrer retiinin «?vfrj- day yvv have wbnt ih cillwl n i^roTluiAN rbvthm 

or tyjK.' ; if Mitiicthinp like forty PiKbt hours int<!rvoii(? bptwiten ihn bo^nning of two 

.-!-• ' .11 tb-it th*- lever roetii-H on tlii? tbirJ dny, we call it T£HTIA.X ; if tbe fever 

I thp founb <Liy (iiit^^rval of Ti boiir*) It is a (jUAnr.vs. Ca&ca with a more 

. •! rh\ ihm t up Vt 28 ihivn) an! wry rare. 

Ihf ironi PAROXYSM i* oftm hraiI wbMi Rpmilting of rnniitt^iit affeiitionR. wbnn it 

in pynorymonK witJi f-xac«>r)>nt)oi) ; in vrhi<'h wiimb «•« npouk of pamxysnis of tlyxpnicA 

caii3<-(l liy foreitrn bodies In the Jaryiix. by jiolypi and croup. We oftttu cull jMiroKysnui 

(veriiai.olar, filt lUTectiouji wbicb, thoiiiili uot jjeriodii:, CHicur at iiTctfuliu iutervulu, ob 

b^Rleiia, gont, ci)ilc[i«y. 

Tn fohtilo HiscftKoa the following gmttpa, with reference to tho course of 
the Hi-seasp, nry ili»tiiigiii!ihable, though they oft*Tii shtido into one annlhor. 

The short MCBitii.K nifiK-iREH. the no milled atltick^ of frvrr (fohriculii, 
epke-iiieiu) vrhu'h liavc a Jiti-ation of two or at the inortt three days, ending 
iu curv, aiiJ in which the t<-iiiiM'nitnrD siid'h-nly nMrn to 4(1"^ C. and over, 
mnt\ fallt ijuii'kly, iik in tvurgicAl tiiul piter|>i'rul Iruuiiiatic fuvcr, in nmny 
cat»rrh;il airectinris. 

Tiir »'oNTi>'T-rD KEVKn, -which usually begins Ktiddmly, is often iishc<red 
in hy n chill, attains in a short ttiriu a tempenitiirti of 30'*-4O* C. nh'.'ws 
snnill drtily variations, iind dirriiuiKhes rapidly Hfter sevprsl flays, or <d1«n 
a foi tnii>ht {oa iu primary croupous pneumonia, scarU't fever^ small-pox, 
typhos ffver). 

The RHMiTTKST reVEii, whicK rpaeinhles the above in many pavticnlnrd, 
but wliirh uhiihIIv exhibits a marked fall of teiD[)i-i-aturc in tlie morning, 
and slowly et<u8i_*H. 

TuE I.VTKKMITTEST AND iiEcrnRiKO FEVER, which shows perioJs of normal 
tempi'mture b<'tween the uiudKrately long paroxysms of fever : whieh char- 
»cU»r is osppoiully wfll-iiuirk'-'l iu iitterniitU'nt f(<ver (ajjue) and in relapsing 
fvver, h'iia woI|-iimrk<-d in pyiemiii, ery>ii|H']as, and niciiHl*'.s. 

CliRosH' FKVER, which Irtsts for weeks and month;:, seldom uninlemijit- 
edl» ; usually sLowinj! an intermittent or remittont fonu, as in pulmonary 
phthi^iii, ill cjixicn ^'f iiilernal or fxt<;nial ituppuruiion. 

Tho majority of fcbrilu disea.Hes only e\iiiiiit ono typo of t4>nipci"atnrc 
variations; a very few shnwiiij^ sovfnil dift'urent types, as, for instance, 
inleruiitlrnfc fever, pneumoiiitt, senrlet fever, typhoid fever. 

All tlic abovi) *«xpreHsiuus, the tleteruiinaiiou of thp so-called stiigeSj 

depend exflnaively, or in u gvent mensurc, npon ohflorvutiona of the eourso 

nn<l pn.»irrtM of the fever. Such variutionB, with the exception of isolnti'd 

dihtiirtKiri'V« of iho firculation, are rarely observed in anatoinicad altorariiins; 

I tbe«e incivaoe quite n;>;nbirly and stea^lily, sebhim with marked changes, 

t^cither cxACfirhations or renns&ions, as in acuto artinilar rheumfltism, mariy 

^CiWA '>f iiiHommatioD of the skiu and mncons niembraneH, etr. At ceruiin 

iatervals |;rosa changes io tho tissuott (inflammation or abscess) will, of 

cuuiite, occur; hut they do not appear externally in so decided a manner. 

Among intermittent discnKe^i there are some which are nonfebrile, most of 

th<.'m bt-ing pore nfrvnus allcctions, as cpile]>.sy, many rnrms of pain, mental 

lifiectiunK. 'flic lost named dtscuHc intermitb as dtHtinctly, though not in na 

I Mgahir a way, as febrile alTections, and not rarely we can predict tlic week 

■fid day of reeurrence. 

2 



38 



TEEMISATION OP DISEASE. 



HKniori-hn^ea, n«xt to fpvcrB and spasmodic afToctions, exhibit a ilegrco 
of reguliirity in their nfttirn: tui hn-'inorrlmge from the rectum, the liuij^ 
The bitmoiThoiiliil 6ux is very apt, like uieiiHlrualion, to nftsunifi » four- 
weeks* lypti. Oout exhibiu, with t/>lpnib!y olr^ar intcriiiiMiions^ a teuili'ucy 
to i-eeur in perioda of one or two yeurs^ iiud cft<*iier aftcrwunl. 

It Is a( preBtmt impowlble to K\ve an explanation r»f the«e mTKt«rinQR pht^nnrama. 
In the CAM of hvuiorrbiiff*? an<l ^ut it may he aflaamed that bomvthinjc hariofr been 
ctisehargt^I from the body during' tliu uLtack. a rest will uaturally eDsuc until the 
fmbRttuiufl f-hnll havtt ocuumulatoi) auow. E|)ilc[itie and Dcural^c outhrcokA may aUo 
hv liKiked ui^on lui the n'Mef of n toiiHian. or att n diflcb»rg«, though inatu>r8 are not 
made cloaror hy thi^ explanation. The well -marked rhythm of parosysmii of fever 
is oIm beyond our (XJinpreheuMon. 

TERJONATION Or DISEASES. 

■ may termimite in one of tliree ways: — 
Ist. Ry ft complete iviuni to the normal sLute — cure or RErovEBT. 
2(1. Is'iOMPLE-rK KRuovEitY; ur tlio cluiuj;o intu new moiLid coiiditiuns — 

SECOSDABV Dlt^RASES. 

3d. In death. 

I. TERMINATION- OP DISEASES BY fCBC, 

Complete roeovory is usnaUy heralded by the so-called period of eonva- 
le«ceu«?, a period without <h'tinit(> limits, in wliich, though a degi-eo of 
well-bi'iug baa retunied, greatt-r or linHer wi'ukneHS and scusibiUty to exter- 
nal intlueiict'8 rrtnaiii. It is after severe acute diHeu:>e» that tlie mauifeata* 
lions of convalesce nee are most clewly marked. The general M-nbations 
(ff«mfing<'fii/J) of the patient are better, his disposition is hopeful and 
joyful. 'r]w animal a|t[iutttea are iiruused. but longing for foixl in chielly 
sliown. This witiit in justifieil, and nutritious food, appropriaty to the 
jwwer of di^-eHtioii, shoiihl be fiuiUHhed. After too hearty int»ais i>r other 
erroi-s in diet, the ton^^io easily becomes coated, or red and dry. Occasion- 
ally a slight fever makes its npjiearance during di;;oKtiou. The inl^^stinal 
evacuuttons arc soiuetimes normal, sometimes conxtipHteil or fix-e. The 
scxnal desiivs are heij:;btened, |v>llutiona are frequent, and a tendency to 
onanisu is occasionally observed. The other phenomena are those of 
ansmin. The heart, as a rule, beslA slowly, though, at evening especially, 
the pulne-rate may rise boeause of Blight exertion. The distribution of 
bloo<l is at times abnormal, as is shown by sudilcn changes in the color of 
the face. Jiesinmtion in free, bitt eaKily luadi) nioiv fi-eipient by the slightest 
movement. Tlie tem|M.'rature of the skin is norma], exhibiting the usual 
daily variations; but it rises easily in coni^eipu'nce of various exleiiial 
influences, litllt? i-rroi-s of <liet, etc.; variaiitnis much greater and moi-e 
sily produced than those obsorved in health. The skin is uniformly 
inn, though liable to Bweating and refrigeration ; eH|>eciuUy the feet ai-o 
llablo to heeoine cold on first rising. Tlie color is pale; and at times the 
epidermis comex olt, even when no erujilion has existed. The hair lalls out, 
cajtecially aft^tr typhoid fevi-r, small-pox, severe ptierpersl fever, and also 
aftt^r other serious diseases, and even after diseases of modeiute gravity. 
The subcutaneous connective tissue is dcvoiil of fat. The muscles tremble 
after even slight exertions; they are iu a state of uml-nutrition, and j»artly 
atrophied. The capacity for thought is diminished. The special senses are 
uensitive ; af^r reading a short time, or after any small cxei-tion, headache 




TUKMIXATfOX OP mSKASK— OTRE. 



Sleep is iti genural good, altliougb the patient is disturbeU by 

_ nuns. 

CnsVALBSLENtE, as Q rulf. lustB A lon^ time after moRt acute geiicrnl dis- 
eases. ftfUir hH <li<»t'ust'8 attended witb )iii;ii f»;ver, largn fXl1dat)on!^ hionior* 
rliage, ftud 8ti]i[iui-utioii. After tvplioul fwf i-, vsHoIh, Mcurldtiiui, iiiaiif iiur- 
^i<%l dt»eusesr *!to., wct-kH utid cv(-ii inontlin eUpsc befui'e the patifnt regains 
hi* previous condition of nutritiun, nini«:ular and nervons |Kinrcr. 

liovf dofi« WL'ovury iakv pln«% ? By what moans »ro It-Ktcina mode tn t\vh 
ap]M!nr? Is tlioiv a natnrul cttrr, and an artiHrial cuiv? Is tliK piiiicnt 
ciiivd by tliu physici:!!!, or does bt*, as it is cuinmoii]y exjircssud, gut wtdl uf 
hi mi* If ? 

First «»f alK it i-*! a fact that a peat niany disofdera disappear or at least 
may disappear, without the interference of the physician ; this is the natural 
euro. 

Tliat many aifuoLions, particniarly disorders of circnUiion and the slighter 
I diflturbancet* wf nutrition, rpii'Uly subsi'le whtni thvir causes are removed, 
dept'nds partly Mpon the fiu't thiit the body eontaitm a ;;i-eat nninVHir uf n.'gii- 
latiug and cuiii|M'ns!itory contrivHiiCt-s. The Ijist urc probnbly jirrsciit in jiJl 
BTSt4<ms, and aiv in [wirt pui-ply jphvfiiologii^il, in pai-t pathological. For 
example, if the pxtenirtl tcnijK-rulurc i-iso, bo that n)orc water than before 
is thiuwn off fruiii the skiu and the lungrt to the air, the auiouut of other 
excrcttiuns, Uie urine in pai-licuhir, is thetvliy diminished, if tlie atnius- 
pb»^rtc tetn|H;rutiire falls, the cooler air takra up h^as water fnun the surface 
of the body, tbut diminished evaporation of water is eqnt[>oi.sed by an ahun* 
dant dow uf urine. In conite<|uence, the amount of water in the body 
remains the same in either cast!. 

Wf* have in thw conner^tion thrun grout groupR to consider, which ai*e dis- 
tiujfuisfaetl from one another by the moje of union and the ile|tendence of 
tlieir elementary [>arts : the nerves, the blood and ilie glands, and the tis- 
suwi in so far as tbny are contiguona. 

('o«pi!s--i\Tioss IS THE NKitvors SYSTEM cusue eitliev thr^mph nutritiim, or 
by the trnnsfer of the disorder to some other part. If ti nerve be iiffV-cted, 
and it hegin to undergo the change from the pathological to the normal 
slate, it uiHV l»<*, in the fii-st pittce, th«t a stage of trunquiUily and e.\haiu»- 
tion su'xe'-'d* that of iniiutioii, just ju* in sh-ep, as if by a simple resting 
(remperation) of the nerves, ih", it may be that through counttjv-in'itation, 
that is tlirongh a new antl stronger rlisorder, the interior movement of tbe 
tissne is increased, an incii'ased inelaniorphosis is brought about. We see 
the same thing in exhauntion of tlm norvoug system under the tntliience of 
irritating and exL-iting agenttt [wine for example). Or, tt may be tliat Uie 
return of nervu*t to tbe nunmil sfaU; is brouglit about by a kind of SRtura- 
tion, similar to what occurs in liealtli during the fasting 8tat«, in which 
mon^ nutritiouH materiul ts currie<l to (hi; cxImuF^tvt) iliscuscd nerves. In 
all Lhi*si< cases we hnve to deal witli a greati^r tissue-change, whereby mora 
old (etl'etc) iimtcrial is iitmoved, and mure fruah muterial added than before. 

It in nuij to rcfnr to many oompcuftntions in th« ncnrotui Rjrfitem; some dufordomof 
' the nervouH «yKtrim iH'citme ni:tit.rultt«<l iM^caose Die excttntion a» it exteniU front part 
Kto part 19 f^mdually eYVinuxtnil hy tht; reinRtiuine it encciunterii. For KxamplR, one 
I ean eoMiiy oonovive the ternihiatien of nn opUeptio or Iiy!(t4iric con^-ulniTR attAck In 

tuau.T other aimih the trauBitiou tnJccH |ikco with tinytit irregularity. liocAnsc ditfereat 
^ partji are iIUTt-rtiDtly irriittblo. uid fCLC^rlia are iHlcr|>oa(Ml nlou^ the viuious paths. 

Th*Mi itnt only catu>o oliaiigox iu tha direction of impiiliies, bat also qnantitatim 

TsrintioiiJi. fnnrRiiiw or df'crt'uite 
After wction of inany ucrrei the function abolished hy the operation retnnui 

without, aaj rouaiuu of the nerrti ; for example, as after the section of the bplaacUnio 



20 MODE OF CIRE. 

nerve. The exact conditions of the restoration ore unknown. In bram-injaries 
improvement may possibly be brought about by the assumption, by parts adjoining 
the lesion, of the properties of centrifugal fibres. 

CoMPESSATroNs IN THE Bi.ooD take place less in the blood itself than in 
tho.se organs in wliich metamorphosis is most active ; the glands for example. 

A fault in the composition of tlie blood may aifect the whole fluid, or, 
being partial, may involve the blood-corpxiscles, the dissolved constituents 
(albumen, fats, salts). The repair is brought about by a limitation of the 
waste, or, as in convalescence, by the aajuisition of new elements from the 
bIood-pre])aring or assimilative organs. Increased consumption of blood 
elements in disease dt^pends mwinly ui)on the amount and extent of the local 
disorder, and ui)on the height and duration of the fever. The larger the ex- 
udation, the more degenerative processes or even htemorrhages take place, 
and consequently the greater will be the diminution of the blood elements, 
especially the blood -corpuscles. 

Wlien the local proces-s has proceeded only to a moderate extent, the im- 
poverishment of the blood is ea.sily componsated by the addition of new ele- 
ments, providing the digestive aud absorbing organs be in good condition. 
The restoration jtroceeds in part from the direct absorption of food intro- 
duced into the stomach and intestines (water, albumen, salts, fat), in a lesser 
degree by the resorption of substances stored away in the body (fat), and 
la.stly, by the production of new histogenetic elements (blood-corpuscles) in 
the hcematopoietic apparatuses (spleen, lymphatic glands, etc.), 

A defect by excess in the constitutitui of the blood may not be simply a 
quantitative one, by the too great abunda'nce of a normal ingredient, but 
may also be qualitative by the addition of a foreign clement. The means 
of equalization are the same in either case. The superfluous substance is 
destroyed in the vascular system, often by oxidation or by reduction, or it 
is thrown out by the kidneys (bile-pigment), or by the skin or digestive 
tract (uric acid in gout, urea in many kidney diseases). 

In this sense the old Ilippocratic doctrine of eiitical excretions and critical local- 
izations has its justification, as well as the idea of blood -purification. It is even 
possible to defend in this sense the designation of blood-purifying; remedies, in so 
far as these remedies specially increase excretion, and thus bring about the separa- 
tion (depuration) of certain substances from the blood. 

It is not that all such excretion and separation of substances from the 
.blood have a beneficial effect upon the course of disease ; they often, on the 
contrary, become themselves the cause of new disorders. The i)athological 
alterations of a j)art ofUin directly become causes of new attractions and 
relations, and the organ thereby comes to play the part of an excretoiy 
organ for .substances which were i)reviously foreigir to the paiii. 

Compensations in tissues take place in two different ways. 

If the tissues be filled with foreign substances, those may be remove<l by 
reflex movements (sneezing, coughing), by increased secretion (as in the 
nose, aerial i)assages, tear-ducts), or by and through the blood and lymphatic 
vessels (as serum, the colorless blood-cor])usclcs, and in part, also, the red 
corpuscles, foreign bodies deposited in the tissues, as dust, etc.). In this 
way many disorders of circulation and many inflammatory aflections are 
cured. 

At other times a true restoration is only brought abont by the comjjlex 
Way of rnitrition. The altered parts must not only be removed gi-adually, 
but must be replaced by new ones (muscular fibres, nerve-fibres, epithelium, 
glandular tissue). 



TKIEMINATION OF niSKASE- 



CCRE. 



31 



«oft rurMV itidiviiliial elements of tissue* arc wholly destroyed by tliB 
ttlteiittioiiit wliioli tljpy ttxjtCfrienco. Tiii« doi« not alwHy« cause a cavity in 
tlie tissue, "nil! oivities wliicli may lie foriucil are often yniiliially rejilactM 
by uew tu-sae. This takes pUce very mpi^lly iu t^pitbelinl stnictui-ps, 
where tliH wiist*- is nsunlly a greiit one, qu»1 where jii-o existing cicmeuta 
cuuu» !i|) l4» iv(tImT the Uiss. In the deeher purLn the rtfstoratiou iu ao 
much iht' nioru diSicnlt in (iro|torti(m to Ine <U'litsiry (»f the orgiiiii/jiti<ui 
iuit.1 thr conijilexity of niructiu-i- of tlit? jiart- We know, for e.vaii»p>lf;, that 
the HXttrTUiil »kiu and nim-nuK ni'MnbnineN, with their glandtilar upjMirutUK, 
HW never whulty iTprmlnofd ; unit tlint in thw plnen of thn Inst tissue u 
Conricoti*»'-UKaiti' fornuitioii, hiivitifi tlit* churHctera of a scar, appears. 

Purtionlurly iinpurtiint for the orj^^uniitui lut a whole, soiueiiiuen tMny and 
sometimes diti)<'iilt' of exjiUtiution, i.s the ueutniLtzatioii of disi'iLsi; hy ihu 
lArtictpMtion of ori^iTis bearing s* relation U? the or^n drst uflbuted ; thti 
formAtion of a. colIat:«»nil cirtTiiIation, the fommtion of counectivo tiMne 
nronnd foreign bnalio^, even pacHJ^iU'.^; ihc^ tliickt-ntng nf oiic nf the Itoiu'S 
of the foreorto or leg after the excision of the othei ; tbe hypertropliy of 
one ktdiiMy when tliH other is atrupliied or dihea-«'tl ; the bypeitrupliy 
of the lefi venti'iolH in inHnftiiiencv <>f the luirtjc vhIwh ; the iiy|M^rU'ophy 
of the right ventricle iit viirious di^turlmnoiTii of eii eolation in the lungs, in 
dimmler of thu left oathon tt^nosum ; the hypertrophy of organic muiicular 
tibrfH in iuijiitinil cwUhic nf atT-ote'l hollow viscTa, ulc. 

Tlie nnJiv lU'veloped tln^ ni-rvous activity, the more fivr iht» cirouhitiun, 
the uii.ire Ititiiuatt^ the mirmal eoinbinutioUii and cuniifotiotis of ihe 
Aiiutoniii'ul elementK, tlie tnmv easy and cuwpletu the poisKible ni:titrulL;a- 
tioii or luitural cure of lesions will be. Nutuml or ^pontHneoiiK run), if wo 
S[M»«k of it in tin) tibstmct, tnkes pinuc only tlii-ough phy biological proccHsea 
and t-hroiigh cert:tin ti^jecHhary way»t. 

PnEiMHroBiTiox. plavK Hoaie pari in lestutm of |>art», and in the mattor of 
coniiiermHiion. A. pixMliniKwitioii of a part to the starting of alt^rattout) 
ahowA that thi'po ahvady exist*^! 84.>inething inorbL<l. It depends upon u 
dcgTPB of departure from the noiinal coinpfwirion, which wo do not, to he 
snre, ifMfctgnize tu> a state of itaelf, but one by wluch the olumenlarv parts 
are made of mnro unst.thln cotnpoRition. An<l their deHtruction through 
frtrogradn iiietutiiorphokis made eaxy. The piiiitlistpiMitioti nf a pAit to 
dL'<i!^Mt i-M in part cong»'nilal ami iidioi-tt'Hl, in part dcvohjped by preceding 
morbid chuii^'ea. Fnr the alKilitioti of prrdi»fpo.-(ition the be^t uieuu.i is 
j»hysioIogitMl exercise, not merely of the jjart itself, but of all which are Ui 
relation with it. 

Hern habit, ttdcrance, and Hrclirnidion play (Mirts. Tlirongh exerciiw, 
that u through re])fativj ai?tiviti<.-A of a part, thu openitions of viTtiiln 
murled of ufrtivity are fju-ilitated, mOucIi iu their t^ini make llie more rapid 
CKcurivnce of eipndixittiou poKHtblu. Throtigb the habil of ctirlaiu inllu- 
encva, which coinc-idwn with a dulling of iiritabilily, the operatir>n of cei>- 
tAiii actiritiMK ih irtnrdt*d. Con^^i'ipii'titly, habit protefita iu a dillerent way 
from i*XRr(ti!w% by prevvnting tbu uumuie]icenn*nt of Icaiontt. Aucliuiatiua 
ncta io the saniu way. 

In adilitioii Ui the hesling of natui-e (HptmlHutMjim oupc), Is tliere an arti- 
ficial cult-? ThiM in a uiosi^ importaiit qui^tion for the physician, onu 
which is bpftire him nil his life. 

The aiiAwor to this question must in gvni'nil t«rtna de|M5nd upon the 
fD*'ans which the phyKieian has in hi'* ImtidH. It ia to \)0 reineuilw?red that 
thi-»e uieaiov luu^triMnaiu within lIil- Uuiitsof phyaiologicttl pos»ibilitieti; that 
jj^ that Uivy caii only o^ierate in tbe oiannor and directions which havo been 



as 



MODE OF CUKE. 



indicated above. Artificial liealinf; is not, in priucii'le, at all opposerl to 
natuml litmliiig. Siiu'cie and euliglktcued ph^siciiuis hi nil ugps have nlwajra 
aelcnowli'dged tliat they wi'tv only tliH Mfi'tHiilj; uf iiatuif. miui-ntri natuTtr:. 
The pi\>bh;iii ut' the phyHicinn cuiisi.stit iu wcahcutng and u)H>lifihiit); the pre- 
diKpaiution, anri in fuc^ilitattnf; t>ie neuti-ulirjition uf atti.<nitiuuEi which httvu 
alrt'ady Iwgun. Thn p))y»iciati rati, at imy rate, do in hotli direulioiiK what 
would bu done with ditlu-iilty or nut uL all wilhuiit )ii» iutfrfi-n-iuit ; he can 
briiigabotittnany ihini^s iu an artilicial way which " nature^* would uoi cause. 
The phvbician often makes iise of moro quitkly-octing remedies than inilure 
has at )ipr<tiHpu4Uil ; be hums, ties, cut* away, erdttrg<-8 nwrruw plarev, *fic. 
Thonf^h ihiij appea.rfl contrary to natural priicejwfis, yet it is not Aoin i*oaliiv, 
since the same is seen, though much moi-e slowly, in the extrusion of foreign 
bodies, the isolation of pieces of dead bone, etc. It not rarely it in Ihephyhi- 
cinn*H power to decide whether he shall inteH'ere forcibly or let tldngn take 
their own cou)>t>. In internal diseases aiialoguiiH coudittoiiH are pn*£>cJiL : 
wc cuit often, by meiuia of exiM^etoi-unta, eineticn, laxatives^ etc., ipiickly 
bring alxntt that wljioh might otherwise have endang«'red life by occurring 
slowly. The iii>e of cold, in the vari<ntH forms uf cold applicatiomi, tfitx- 
bttths, crmpIeLc batlis, etc., fnrniitbcs us vrith a means of redticiiijj dan- 
gerously high temperature of au external or internal |ULrt, or of the M'hole 
body, by one or several degrees. And, further, o|ierations upon the ner- 
vous system alford most excellent opportunities for the phyKician : he can 
bring alxint an early resolution of tension in the nervous syHteni (by meana 
of morphia, digitalis, hlei'ding, denvativcH), he can so act upon iierveH as 
to atimulate or iiaratyze tlium (acting upon the pupil by wenua uf bellailonim 
and Calabar liean, upon the canliac nerves by rligitalis, ete., an<l njion tlie 
vaacular inTvr-t by niHana of nitrit<i of amyl), he nfteti can make ii*rL'guhiT 
BOveuietit.Hof the heart at,'ain rc^ilar (digitalis), etc. It in also poiwible to 
. n|)on the blood, as we can directly furnisJi materials for hwmntosis, and 
wc can 80 n;pdate, diet as to provide in abuncUncc the ingnnlicnts needed 
by each indiviilual cius4\ Kven niKni the reronstiiution of titiAucK we can iu 
many ways exert a dii'eet influence : by agenLs which facilitate resorption; 
by Uiustics, astringents, transplantations. The physiciHn should regulate 
the external coudiiioiis :inr} intluenceh which iip(^r»te upon the uiorhiil tttate, 
be can act new external con<litions in action, which without hib interference 
wonld not come into play at all. In the sfiecial trealnient of lesions it can* 
not be said that there is a blind expi^riuu^'iiting with means; thiK woidd be 
neither in the int.'.i-fst or scitmci^, nor in that of the patient. The medical 
matt has en<iugh tn do, if lie makes nseof earlier experience with due i^n* 
sidenilion, and every tliei-upeutist who clings t«i the laws of natural .science, 
and iloc« not ventun- beyond the facts, must acknowledge- himaelf to be a 
rational empiric in the treiitnicnt of disease. I'un' empiricH, tliut in, (Jiofte 
who treat disease by post experionce, without judgment in reality, do not 
exist. For, accurate conclusions are dmwn even by the roughest analogy 
from lh« iinme<liat« exhihiliiui of mt'«licine». He wlm rellecta, who takea 
one, two, three, or more cireumstances iuUi considttratiou, instead of one, 
when seeking au analogy, usually treats rightly. 

Artificial healing is therofrtru not wholly identical with natural liealing, 
but neither is it opposed to it. Artificial healing makes uae of Un^ ten- 
dencies and forces piesent in tlie b<xly, and through them, by the help of 
mure favorable eii'cuni»taneei<, artiticially produced, brings to {>aa.s the pos- 
sible neutralization of lesioua. 

(8w ViRCUOw, AUff. Pathol, pp. 15-35.) 



g^^ 



TRRMINATIOS OF DISKASE— SEOONnART DISEASES. 



^ 



f. TERUINATION OP DISEASB IN INrOUrLETE CPRB— SECOtTDABY DISEASES. 



A cure is said to be incomplete vrlien there atill exists a temlency to dis- 
ttK. It is tiot nosriible to indicate with precision the conditions upon 
"wliich tluK predi»fK>sitioti dejtendit; it mu&t be iiyi^on changes in fomi and 
coui|K>siiion of pui U; lint HUi-h miuuce OQi58 tliat lliey have, up to this liiue, 
escnpe^l our un-ans of investiijation. We more |Miriiculnrly meet tliis pre- 
di5.jnihitioii nfti-r many infhLnimations of the skia, niucoiiu ineuibrunea, the 
tuUflilN ItingH, Hnd jtMnts. 

Cotttrarily^ iu many diseases a predisposition to recurrence is destroyed 
hj a 6rst attack| sometimra for a time, somotimes furever. This it) more 
especially the ca&e in uifectionM ditieiutes, shown in the nu>8t striking niatiiier 
in yellovr fever, typhoid fever, snjall-pox, aairtet fever, mcaales. It is irt 
the pi-cseut timo quitt> impossible to explain these facts. 

lycoxFLZTK (XKK IS diHtingtiished from socoudury nlfections by its being 
a rpmHiuK of cerUin morbid tonditioriB, whereax Uie latter consist of new 
morbid proeeasea. Sueh conditions*, which are not always referrible to iIih- 
tihcr anatomical lesions, are^ for example, pumlysiH of the exti'eniiLi<>B or 
ofiudividu»l tnubcle»; others, whidi do de|iend npou R[>eciul anntnmical coa- 
ditioiLH, are t]i;tloc;ittuii8 of bonc«, distortion of the skin, narrawing of cauals 
by tJ-ai-H, twisting f>f the intestines by unnatuml fixation of its serous coat ; 
or others, which are partly anatomical and chemical pi-neesHoa, such as di»- 
ordera of gastric or inteacioul digestion, dLipoaition to fliixea, etc Or else, 
ut entire nrgiin, a limb, is and retnaiuB destroyed, as afler ulcerative pro- 
~ eossee, after gangrene, etc. 

The conception of SErosDAHY AFFEfTlONS is like the majority of medical 
ooDceptiouR, not easily made out in practice. For inKtunc**, Kecondury alfec- 
' tious nre often confounded with what uro culled rouPi.[i:ATiONfl, that i» to 
■y, a Kuccooiion of morbid pn]cc(«ins, eueh one of which depeudu upon the 
othen. In articular rheiiunitism we meet with indamniation of tho poii- 
canlium, or endociu-dium, in about one third of all crsi^s. If thi»4 take plaoo 
«t the aaiuL* limu tut the rheumatic attack, uuil if the phyHician discover it^ 
be ftavR that the rheumatism iH in that jiarlLcular case complicated witli pori- 
or endooarditin. Often, however, the signs of thu eardinc intlnmiuatiou are 
indistinct or unnoticed tluring the attack of rheiitnatiHm, and it is only ftftt»r 
the ceiwing of the rheuntatiMu thut tlie cardiac lesion is maile o\itj in which 
csae it lA citMloinary to speak of thi^ heni*t-diK(^a»e as a secondary Htfeerifm. 

When we spealc of secondary aifet^tions, wo must make sure that thei-e bo 
B causal relation between the first and second diseu»c8. I>etinite imatoinical 
alterutiona must n'lmiin of the Brst diseii-se, uvrn though they ]>roduce lio 
symptoms, or if the symptoms of the second disoHBi* arc nverlooked during 
ttie course of the tirHt. In this aenan piiltnonary plithisis in not seldom a 
disea*ie secondary to measles, habitual diaj'rhcea or oonstipuLion secondary to 
dyseiiten-. etc. 

Furthermore, a number of the pioeoRaeit termer] moLostalic bulung to this 
Category. In former times, by hetastasis was unilerKtood the transpiKsitioa 
of fufU^ri^t nwrbi from one part of the body to another. Most usually is 
this iisf* of the torfu now rctttriclod to the transfHr of cryM|W!latou.Hiiif1aniU)a- 
tioD of thenkin to the mendu-anea of the bmin, the swelling; of the epidtdy- 
nisat the same time »*ith cessation of the gonorrlueal di-tchnrge, the occnr- 
rencD of inflammAtory swelling of the testicle siuiulraneounly with diminu- 
tion of a fmrotid ititlamiimtion, the setting up of n cardiac or |K.'ricaiilial 
itifUrnnuition at the aanie time with the cessation of rheumatio Joiut-iutUm- 
tnAlion, the so-called metastatic intlammatlou in pyecmia. 



24 



TEtUUNATIUN BY DEATff. 



III. TERUINATIOX OP DIRBA8E BY DEATH (THAKATnLOGT). 

Death is th« suHpeOAicin of tissue metamoipfaoeiB, ita chnmcteristic symp- 
tom is the ccHHatinii of tlid riiiicUouH. It Ih iinccKRary tn ilistin^iiiNh tiic:il 
<l«m()i, ilio <]eutli of u siii^k' oi-j^ftri, froui j;eiicral ilualli. ICvcn in gfueml 
<lt-iitli iliir JftHMiKL- of iiidiviJimt [niits of the body dues not fullow ui nun 
liiuw, hm lukiiH iil.ictf BuccoMsively. If tlie function i)f mi oif^aii or p»rt 
in vety iinporliiutf wv aiv «ooii made awarn of its dcnth ; llii* tU'ulti of tiie 
bi'ftiii antl liCrtit is instantly i-ec'»giiizftl. while the loss of ft kidufy i» iucer- 
taiiircil ouly :it tbo ftost tnortem exam i nation of the body, the death of tba 
hair ia typUoid fever iiivt becomes natioe^lo during cnavulettcencc. 

Wc irtill frfqnently hour it fitAteil that one of the fti^rns of dtath h tliAt the 
t\vn<\ puita uDclvr^o [i)itr>^r:u:tioii, rer>olririf tliemsL'lvt'M julio simpler toiupoiiiiijt- ; hut 
thLi M in reality uav of the uoUMinneiiiNi*. of deuth. This HUpi»oM5d chamctor b. 
furdUmuort', nut invariiihly prcKtuit. oa the hnnes and tttit)! art- liiit Hli|^''ht]j chot^rd 
chritik-ally iu dt'uth ; nud tif*Mt'1''n. n tH-rvu which is cut in tli*" livuiir ttiibji-ct it. dead. 
and yet doe« not unilor^o -I' ' •». The i^etMation of life alono if> not. trifBrient 

to bant the tKind wbieli hi>l iient* toacttier in coinplftx atoms ; thi:rf muet 

nfral lit.' bit iiiiputita fcoiii » iiiinit, I nut of hL-itt, iiiolAture, fuiijfi, eto. And it it true 
thut. Its a itde, ihtMn «lo not CaU, &ud wu cxitufcquuuUy buvo puttcftictiuu an a si^ of 
iirecoTenible loea of Ufc 

The transitiou from life to death may ttkke plu.'c vitb absolute audden- 
neat). Itk thi.H Ktrici itHUHc du:iLh ijikHH phu.-H <uily hy U^htuiug, suusLmkn, 
bruiHiug ur hiconitiu;^, i*uii.sUot wouudtt, dtiriit^ birth utid eouUtituut^Ql, dur- 
ing KL-vci-u oiM^rAtioiiN, in iimuy cuiidilioiis i>f itit^jxicatiuu, and iu. cri-tiiiu 
eaoniiou!} internal liiuinorrhugf.t {opoplrxia fulminmui) ; and thia «vi.'u iu 
]i«i-Kiin8 previously Kunnd. In kucIi etuMts iL in noticed thut the utlitudu of 
thr body and tliu fariul t'xpitiiihiun uix* jiitd uh tJiry wi^re iu x\ni lost nionifiit« 
uf lifu. AH is tc'btitiftd by the bodieit of KuicidcK, and the bodies runwiniug 
upuu the buttk'-titdd. In wiiikL!nt>d petBouH, iu convidt'^tt'nU fri>iu pru- 
I'jnj:«'i| sevpix* dirtfast'S, iu wrtaiu di»eutie9 uf the heart tuid bnuu, asiuiiUrly 
suildi'M uiodo uf dfwth has l»eon obnvrvtHl. 

In thv vast nirtjot ity ofcAafs, In i wever, death onsuoa in u moro or leaH gradual 
nianucr; ryruiin signs precvd'' ita uenurit'uce, and foretell itaapproAch. The 
KUij^e in which Uii'w isigns ^>^Je^r is cj\llftl lliu agi»ny or <Ieail) »tinjj;i»le. It is 
culled u xtrug^^li: becuuHt.- it rinmctinu-.s Uiki-Ji plwrc with syinpLouiK of rxcilo 
mi-iit, chifHy attacks of [Hiin iitid .sjntsniK, and iM'ciinse it \a iut(-iide<i tlntrnby 
to ilcsi^uat^ in 11 ptK^lical way the mutiny of the vital iirincipli? n^uiiiiit 
inipiMidiiig annihilation, lluwever, death not seldom cuiocs tiuiotly and 
noisidhRnly ; ic ia tJin kIih'p of dt^lh, hu connuon in vury aged individuuhi. 
The strength of the body beurs nu relation to thu kind of agony; the 
strongest subject of apoplexy sluuibcrs unnutioeit into death. M'hile the 
UKwt emaciatei) consumptive may struggle fur duya before t«ruiiiuiting Uia 
exihtHuce. 

Till' ithenomcnu of agony are iti nf^arly all cases uiiide up of the symptoms 
proper to the di»oaH>* which bitt citiiMid the cessation of life, und of sigu.i uf 
jirugrej*ive pandysi* of thu nervous and ujuseular Byrttouin. If piilsy was 
ptvviously present, it reuiuins ; or, if the iliaetwv wuh chamctiu-iwd by 
symptoiau of irritation, theso gradually subside. The mental facujiitts are 
UKually ilitniniitheti or suh[>emlod. The luoiibuud, except iu thuse rare 
c»iM-j( in whicli couwiousncus it» n-tained, is wholly imliflerent to all his sur- 
roundings. Most luuully consciousness is lust ; sometiuie^ it rrturut^ ui the 
lost moments, and there is relative ipiicL afUH' pre-uxiKting pain, etc., signs 
which aro claimed to couttLilule the phyiiicul pleaaure of tlie dying— 



TKItMINATlUN OK mPEAfIS — HKATri. 



25 



wliioh iinvelUU nml cxcitnlilH n-IiitivHS iilwu}'8 ii-'hite witJi iimny t;x- 
rutioiui ^tUu 1.1ft woriJs of tlif ilyJi^;, tin* soc:ill»'<l pcBtitsy, or raticmntio 
"vH/rvftitiitin). TLe luijuvjutliced itliAerver &bo8 in tlie quietudu tUe progress 
uf imntlytaR, the couiniencitti; luMt uf aitisculur totiiiR. 

"I'llf *TiriuiiK Mpiml-tttuHes lUo In a tU'titutf', BOiiiewliiit ri'j^ular silCiVSsioii. 

If cuU!>'-■i^»^lMl^■^s it* |)n-«;fV4'i.l, tin: M-iiai's Mir%ia'. Tlie W-'Iim* of smell 
and tjiAtv uix- ihu tii'Mt to fail : then iibuallv folluws bight, iiiul the d^iiig (ter* 
fiua liul uufio^in.-iitly coriij»luin8 of WA-Liig Fog, or odU I'ur W'^Ut. Tlif rtCMUS- 
tir M|>{inriitu?s iu still iiii|ii-esseil Ity .suuiitJ^ when visitm irt i}uit<j iliiik, uixl 
it U liifcaii&e uf this that tlio ((Oi'Suiis j>ii'.Hetit hi-uuikI the dt.'alh-bcd iniiHt \ie 
vfATUvA aj,'iiinst niakin^ indi^cn't^t imuiift^tAiioiLS. The (k-iiso of touch la 
•oiuuliint'tt snuii itiiuiuishi'd, and 8i)uii>tiint>it it is tlii! liml to wholly ditt- 
ap|M--ur, u^ tb«i irriUilitlity of iIk> (ttnjuiietivii for exuiii|ih.'. 'Hie ilyiiig not 
rttrr-ly f«;l the eold which is crttcjiiti|' up from below ovi.t the lnniy. 

Of tkeniusck'ti, the cxtcniid unrii :u't! thi; tiist to l<rto thrnr propt^rty of 

mipoiuliug to the will ; movements luo tiTuiulous, i-atlnr fetbly t'onvnisive; 

itonietini>r» inoro or less gcinfralizi'd niu.-H-Mihtr coiitiuctimi^ oiviir without 

producing any ti'iiHiou of teritlouH or inovenieiits uf liiidiN ; Iho hody 

faliduit du^iiwurd in tho buiI, thu liiiihH, in iircordaiice with giuvityT full llku 

lead when ruised up liiid ItH g(j ; the fiuiinl liiiduiiniits ai'v Imji^^ard. the lower 

jaw ilnMipKj the eyelids full down over the pyea without rov-iing theiti 

Vvhoily, Ihtt nxt» uf tlit: eyoA twv purtiUcd, the [nipils UKiially simiH, thdi^fh 

Flx*couiiug Vf ry liirgr Just hefoie dfiitll ; tliu cnijuuctivju iiru leddeui'd dining 

a pi'.'I'.'Uged iigony ; the eyehidls ait' no longer fixml, tlm coruoi bii-finies 

lumircies^ ikud lluvtud ; tliu tenijdi'ti kIuIc i.Iuwii ; the nn.sR ht'cuuiea poiitt^id 

and Hpptutrb eK>tigut*'d ; the outliuea uf tlie Juwh bi.>c.v)niL> more evident 

tbrongfa the limp niuacluM ; the elan n[ipeiii-i( more pointed and projected ^ 

tlie lips lire dry ; the face yelluwiwh, hI tinier hltiiHh, oudl, uflvu covered. 

with cold, clammy sweat — wu htt\e (he fWUa Illppocmtieit. 

Tlie bivnihing becomce slow, infreouenl, iind Uborioiu*, the regptrat^jry 
movcmt-ntfl oi-e for the most piirt dLMinnlar, so that Ht^vend miiM-rflciiil 
movements follow a dcop mm ; shorrly b^dbro doath ih^y hei*onn) htill moi'C 
rarv, utnl, with the exception of h few movements of hlccnngh, and of htgli- 
ing, are very easy. Ni-nrly alwuya the bronchiul tubfs are HIIol with 
mui^tiK, wliich ciUiniit U^ i-xpelled by congh ; uud we have nt the end audi- 
ble rules (the Ho-oalletl di.-ath-rtittic). The tlntmt ih wiilely open, and lUo 
OMophagus jfunilyxed, so that beverages fail into the slomneh with a I'uuibling 
Iiuuw!. The spliiiicteni resist Init feebly, and «to eusJly overp<>W4*n'd by the 
uiUM.'U% of the viMcera which are only reh)tively puwnrfiil, so thut involun- 
tary cvacuntions of fa'c«a uiid uriue iu the bed are i[uite ciMuuioii. Mueh 
iDtMW wldom there occurs laclirvumtionj or an emission of semuuor prostatic 
fluid. 

The cuutntctiouB of tho heart bt^eome unequal to lh» peiTdsting tonu8 
of tho arterii'it; the HrtcrieH art) le.Hs mid letw lilluil, tlm pulsii becontes 
small, frequ'-Mit, and at la^t iui|ierce|itibk*. In conm^pience, the put.int akin 
luiies its rcdnuHii and tnrgeswnce ; ihe fuct esiKviiilly b«eomr«s suddenly or 
gnulually blanched, showing sotuolimen a ting" of yellow, except, in caso 
of diHiuiter in the le^iser circuhitiifu, wln-n it In iihuatly btuii^h ; the sebaceous 
fulliel(»« are ]>rominent; the hair and naiia H])]'ear elougiited. Tlie vi«iblo 
niucouM membrHues unually are of the Huiue lint as the face. In fever* 
patients the temperature often rises by .5^ or 1"' C, during the itgony. In 
many cahos the elevMlion ik Hudden and very great, eMpccinlly in nnmui'oua 
cerebral ami infectious diseaaCM. lu thejse cases it i.-* altrn not rarely ob- 
served that during a few minutes^ a ijuartCL' of an hour, or even on hour 



APPARENT DKATII. 



after the last breath, the raei-curj- risfs wvemi tenths of a degtre. At the 
suine time iho eutl of the no^o (uul ears, as well hs the hiiiuls au<J fc^t, 
UsuhHv feel cold. Tho contrary in ubm-rvtHl in tiioM: rat.t-s in which the 
pAtieut, atfectfid with n pyretic or npyrx-ttc discflse, nxhtbits in the agony a 
fall of touijiointurc of I'' C, or more, U;low tlie iionnal. This is, for exunijile, 
the rule ix) cholmti, ufter acvi'itj hmmoirhuge, in tleuth by inuuitiuii. 

An exact knowledge of the fTinptoros of the agony has not meroly a theoreticul 
but a |>nicticA] valuo ; enabling the physiciaii to iufurm tho rcIattrcR of the approach 
of certAui di-Atb ; to stop tbu giuug of uitdicanieiitK propt.-T. with tho cxcvpUou, untifv 
peonlitu- t»r(^uni«taiiC4w, of nita«<tliL*tictt (uuthtuiOMn) ; in CalHnlic couuirie? ttt uoUfy 
the priejkt ; mid hImi to mokn preparatiimH tor the perfonnance of bpnrntions (the 
CnMn'im B'-otinn fnr exatnpU')- 

It JK ditTl<:iiU till ih<^ |»tiy!<l('.iau to ftUttc with pr^iKJon the exact moment when 
di^ath takv.n ]ilai<^. Usuail,v a lM»«t brcjitb iit ttaen, coii^ikting ntiturully of nu expiratitm, 
and ihlsin cnnxiilcrod thftend uf life. TtiitfM>iret.iin»«the respi ratif ins arr U^warrj the last 
most in'ejTiiIar. su that often after what Heeins Ui»* Inat nscpinitfou thfcre wciini another 
tioL«y nnrl^man-likc, onu-half (otwo luiuiitc-^ later; and even aft«rtbiB truly laxt breath 
sigUK nf lift- iini (tlm4TV«.tl in other urKunii. If wu upon the uhest of auiiualit iuimtnJi- 
Btt-'l.v afttT (h-ath. the licart i« ifeeu iM-iitiu^ )(i»ontaoenuJtly. (Thr^ expt'riiiit-uLA ot ^n 
[ Eajjlii-h LViiimjitl-fe nhowed that in nuphj-xia protluccd in AngK by thr inlrodnctinn of 
ft tube in the trachea, the cardino coutrnctionp> lantcd an Inng as three raiaut^n flft^'en 
aecouds aft«r the laat respiration. ) The arU^ricft, tx-for^ they ooUapso forovor, drive 
tbu lihxNl into the vcin« ; Ui them aud in (lie ca\itic« of the heart where the blrnHl 
aocnmulatea the more, the louder th« aj^inj^ lu<U« and the nior« nlowly muhoutar 
power failn, the fibrin cflu^Iat«fi. The ihiw of lymph may laat one honr or morv 
after death (BiliriF.lt. Lksh|i:r). The oiusclcn rt'-ipond to electricity {ri>/c infr^i); and 
if artilloml re,Hpini:ion be performed in ii*iphjsint«'<I nnimniK, volnntary niovcmentB 
return, if the aUl'^ininal cavity tie opened, the muscular apparatus of the ini»'t>tine« 
o(iiitrnnl» t^poiilaiiPiiUKly, dr by iiieaiiH of clntricitv, fur Hi;vHni] houm »ft«r death. 
That in the iteriphnrHl nervea tUa prtiiwrt^liH-tnunerrH-furcHHurvivea awhile, isahowu 
by the dhtoovory of facts upon dead oniroaht. 

An lon^ as inAiiifestAtions of activity take place spoiitanpouKly, or can be 
artifidally provoked, death is not genenil, and a general revivilicntion is 
not iiii})0»»ihh'. If W6 deliiie death utt the definitiva auKpennioii of all vital 
maiiifestjitiiHi-H, we ninst allow lietwccn the laat breath and the ti>trtl and 
in-etrievable eosKatton of irritability an interval of time, during which life 
does not manifest ititcif by any plieuomena apprecinblo to our beniK'S, and 
in which we are to 8U8|HMid judgment npon tho rjutitition whether the tuiib- 
jei't bchiKirfl to the living or the dead. If a 8iek ]>i>i-fton bau exhibited all 
the above described bij^uh of ft;;ony, it can be safely &aid that after the last 
breath the i^ettt of tlte orgitniKni will soon wholly die. Tlie cardiac contrac- 
tioMH wmn c»';iJK« afiiT bi-eathing han l>een anx'ated, anil then there is natur- 
ally » ii('>ppii<.'e ill the transport of oxygen to the tibsues, lo whose activity 
tliia gas is iudi>|ieuKuble, 

JodAT {8ur la mart ft tf* i^tmet^m, 1854) calla thin panage of life into ahMilate 
death »u>rt iiifArmMiuirr, ani deccribes Brveral cawn in which it wa« proKtopM us 
lone at tw«l\e hours. Accotdinj; lo von Uajwhlt (/)w f^hrerom T/hIj- ninl S^einfttlf, 
I., lHG2) many cascH of apparent death belong to this ctaaa of phenomena. 

By tliH term ai'Pahent pkatu we understand a condition in which all 
maiufeKtaliniiK of life, if not ultiigethcr ubNcitl, are so tvdnrt'd to a Hiiiiitnuin 
tiiat the atTeoted pernon beura a uiusi exivaoriliuary reseniblatuv (<> a cnrp(w>. 
It IB only by oireful obttervatiuua that then; are diHCovered a slight in»[diu- 
tion, a feeble c:u-dtae contructiiui, a hanlty noticeable and transitory niutieu- 
lar contraction, eapccially ahout the face, eyis*, and lipa. Con»cioii)*ni*K« and 
sensibility, and even animal heat, are hardly or not at ull n^cognizable, aud 



AITAKKfrr DKATll. 



27 



the HeiiHfl of AUiIttion nluno is Hniii(>tiiiii!8 normal. This ileallilike tttntH uiAy 
endure for bout-s and daytt. T)ie powiibility that, a minimum of vitality will 
Buffit-e to pi^vent the decoDipoaition of urguuic nmtler, we acr^ in phiiits 
(luring the winter time, iu the jrnpa utate of insectti; mottt niarltetl, however, 
in hi)M:Tnalin>* anJiiiiilH. 

TLt< fu]|Mwiii<; viiriuttes of appai*ent death have been defined in acuord- 
ance with cauwjs : 

1. AppRi'vnt death in conscqiience of internal morbid states: derp syn> 
C0|m «ft«r extreme fatij^ue frotu long man'hea, after extrenu'ly nfvi-rr labor, 
rarely after prr>lun)|^ hiingHr (tthip wreck eil Hud insane perHonK) ; severe 
eiMuniodic, hysterical, epileptic, and ecluinptio selxures ; catah^pMy and 
lelhnigji' ; the oAphyxiul form of Atuatic cholera — many forniR of yollow 
fever, the pi itgue, typhoid fever; tetanus; convulsions) iu childrenj pro- 
longeil ]>aroxy»uis of nervous asthma, and angina pt'ctona. 

2. Apparent duath from oxternnl imprtWiionH: oxtenHive and severe con> 
tusions afier corporeal punishment ; a high degree of concus.siou of the 
brain, esiMxrialty after powder exploaionH; severe or nunu-rous wounds, 
pAi'tictiliirJy tliowj accumjuinted by tuudi Kli»»ck or great lt>sA of blood ; fre- 
quently after aevt^re hoMiiorrhugeM, in ptierpi'i'aj wunieii and Mtnall children. 

3. Apparent death from fij>eci(ic rauseit : jt|t|iaient death from bix-titliing 
irrespirable gBses ; apparent deat)) nf the newly horn ; apparent death from 
drunk«-nneft«, luuiging, and citrangntation, from freezing, from ran.Taction of 
tlip atr, from romprcissiun, or from bnrial under earth, from fureign bodies 
in the mouth or phiiryux ; apparent death from Iiglitniug-&ti'ukt<, from heat, 
from naix'otic intoxication (opium, hydrocyanic acid, cbli>i-of(H-m, volatile 
earbou compounda). Occaaionally several of tliese cuuaea cu-uperu(«. 

The ]«ssQT grades of appareot doath, thaw in which coniiciont^ueKK is prt'^orvoxl while 
the ability to perform movementR ii> miRpeodcd, arc Holdom mnt with ; they are most 
ftvpieat after poisoning with cnrnre, niootln. chloroform, proUixide of carbnn. 

The appareut death uf the newly born yiufi/ti/ri'i nHnnU"rniii) la of the ^Teatest 

pmctiua] inipurtaiK^o. Scut'LTZB deftues ibiB uuuilitiuu ax an lupU^xia of tliu child 

uorri Hviiii;, one (liivelo]>ed In the nterua, aiitl on« whji;h may he iiit^mipted, not 

leadliig int>TitAhly tn n fatal terminntinn. The aauHw of tliiH cnnditinn, pmdntwtl by 

Bsi^yxia, by impeded plnccDtal ritiipiration, an partly in the fa:tus. partly in the 

nafcenial oitraniam ; among the principal are : promumrc Mporstion of the plaocnta, 

ODaipreaBiDQ of the umbiliual conl, biumorrho^e. pressure on the brain ; of less im- 

portanoe, are : too long duration nf labor aft*^r tho escape nf the wutcni, too lun|( 

■ dicratioa of individual pain^ too abort intorvaU betwrcn patna, apaiun of tbo ut«me, 

\ luBmorrhage on the mother's part, opiKUi-ut death of the mother. Some chililrpn, ap- 

> fiaKnUj botu dead, ahuw a turbid, piirpliub akiu, injected niid often protruding ejra- 

' Itallt, their musdesare Uim:tiv<.- tbuugb tbcir touu-t is bui Utllu or not at all i^iininished, 

tba TCMwIs of the onrd atau'l out full of bluitd, thu umblUcul urturial pulw in mora or 

leas flinw, Dsnally full, Otbim ezliibit n {Mile, faded okhi, relnxtxd muiM:U:s (banging 

down of tbs loA'cr jaw and the liaibx, pabiied anus), thit uuibilicnl vrmrpIk are narrow, 

thoir pulse sraalL infrequent, or altofretber wanting. In the first d<>fii>ed clase the 

respiration usuall}' in absent, {n the sceond it is usually present, though rare and 

Jerking. The former are called apoplectto, the latter aQseraic apparent deaths. 

(Compare B. S. Sch01.tze, Dtr Se/tfintott Ntugeborenw^ 1871). 

Apparent di*atli In of esiHicial intere*it, because of tho possibility of the 
eubjecU of it being burienj ftlive. This occiiri-ence is pos-sible with early 
burialh (in sumo countries six hours, in others twcniy-four hours after 
death), and when tho verilioatioa of tho dejith is neglected or curelcssly 
zuade. 

The dreud of being buried a]ivo Is based first upon a series of caHen, in 
vhicb patienta, considered as dead, have come to tltomselves just previuua 



28 



PAKKNT DKATir. 



t<) iii1*Tiuent ; second upon Llie f«ct tlml imIividualH condmnn^d to di^ by 
liiUi^iiig liave coiiitt KHU-k to lift* iilVer i-xccntiuii ; itud litstly npou lliu facts 
tlijit siijijuisod cnri»a*'s htk\f. shown si^jiis of life after the eniiuui'iicemwit of 
au uuta|):iy, aiid that woueu buvo shown ttticU tti^iis after die Ca-saruuii &0C' 
tion, 

Tliti giVHter mtniber of cmtes of Iniiial nlivu aw not well establiriheil, uud 
the vuriou.s cu'ciiiiiHtaiiceti hruitjrht forward oh proofn of tlio fiirt can ha 
othi.*nvijse ux]>hi.Lnt:d ; thU Wing tine uf the nniiaiiirul |iL>itition of tlio ciirpiia 
ill ttiL' coHiiir lutises heard in ilie vault, mittilatiun of the* tiugcrs, njipaiti'iil 
gidwth uf luLir, etc. it would seem tbut bondjuie easvs of tliia kind ord 
very raix*. 

Tlie dread of hcio^ Tiorii'd olive is aa awfiU one, and jet there i* in Txntb but 
little biutfa for the fear. ThU is or>t bcoaiue iif official rerifiaatioti of lh<i- Mgtt» of 
death, eic., for Lliati U rery iniiK;rf«u?tIy cartiud nut iu ciLiefl, luiil particulurly in iha 
ouaDtT7 ; but Ih'cuuhi the iiim-» htv rare. The Hubjetttt are uniiall.v u^-wly Niru uhU< 
dnn, dmuken. or banged men, or it occars in cai-es which hare, previous to the ap- 
pcamucc of seeining deiith. buipr;«ed pbyMciuna nofl laymen by Ihi^iv remarkable 

Sniptums. It in ubJL'lty aiiiou(r wuiiii-u uf bvKttnud, tu-Auue, eatnlfptiu disptMiUou 
at we lutet \t-itli tix'^L'H in whit-b the HubjicLx can \w fur uue ur evca tw j wuLxit L-xhib- 
itiiig a co!<l, [>ult> Kkin, rathtr Iticrd tyf-liailfi, hardly ]H'n;('pti)'le piilM:. ^vry fn'nt 
CUwao wnitKl.i, tuid hardly rncuffni/abh' ^o^]>irato^y Tnovvinoiitx. FnH|iiontly m imch 
MBM tte ooii6ciouwng« and hearing arc inta<:t, the itatiento tm-l their fminlul sitna- 
tion. hnt ore uimMe to ^vq any manLfestHtion of activity ; renn-jiibfiiiijr nft^rward 
atl tU:it tnii>«tjire(1 round about Uiem. Such enacii uu'loubtcilly do occur, but tbe 
auinlwr of thime wortby of rxt^lit ik verv Kinall |8KonA, ZritM'hr. ti (iftfU., tL Wiiitfr 
\Anztr, VU!.. \\ 401 ; Ro^ENTIlAI., H'lV/. lunt Jii/irli.. 1^72. p. Sl»7. CiiiniiarH al»o 
'the cpsetn collrirted, the majority without uriliui^ui. by Uituiiifcu. Fmkti;kkixk, 
B»jL'cuLfr. UiiiyuiiT). 

The iiieii.'>ui'eM for the prevention of (irenrnturc huriaJ arc : the prohibitJUK of early 
intrnni-Jitx liiHualEy, not Nooaer than fK!venty>t»'M hour^ aftt-T iltiatli), eureful vralch- 
iiiL; of the bixly in the room where it \w» before burial, or in deaddiuuMca; and where 
tliis cannot be done, oblifratory ui0|teetiou of the eoriHe. or oblii,'ut*ir>' Jinloiwtei*^ 

(Compare IwstiJes vnn UahsKLT. Ou.ht. i.e UoS, /Jr hi m-rt nf^uirrutr c( tim inAlt- 
tHutivM pt^uMtnret*, 18(jll. FaL'IIK, iu Archicth ffcitimUa, ll^U, Janvier.) 

TIiH means of dlstin^iixhing apparent from real dt»nth, and which may 
iilso serve in [»art aa uttempltsat reMiNciUitJon, aro tin* following; 

The n;sjiimtor_v mul ninliac inutenieuU continue iu a verv ft-elde wny in 
apparent death, not at uLl in real death. Gwat reduction of tU«?(*e movc- 
nieiite uUo oocnn$iu deep morbid sti-ep and In ttyneope. 

Ju oj-dcT '.o deniontitivte the bivalhing, we hold a down fi*»tht.*r or a ]i^ht 
before the nasal aitcrtiireB, or we pluL-o a »tin:«II glaKK fontjiining water n|H>ii 
the epij^JL-^trium, and obaervn tho ohciUaliotiB of the Hnjil, or we hold a c«t.l.id 
mirror bufoit? tlie month and iitwcrve if it*i polish be laniiKhed. Theao 
tMhtaari', howover, by no nieaiiH absidnletv eHrl4iili. 

In order t^t ulMifr\i- the cardial niovenienbi itUHOiilt.aiiiiit of the he-art for 
NEveral minutes is to bt; recommenilt^l. In a nunilier of easeh of syncvipft^ 
iu^Y]tliysia of the newly bom, choh-ra, etc., this yii-hls a n<f;ative remit, 
and yet rrstoraiiou takes ]>laee. BeMidcB, it abnuht he n'raeudn'reft, that 
in the living the eardiae movL<inonLa may be inleriiiptcd for a Hhort time 
by ariilieial me^ms ; or, by ucupuuctuir' of the heart's apex we noto wheilier 
any movement bo commuiucutetl to the needle ; or, lastly, we try lo ascer- 
tftiu whether the circulation eoutiuues in thi» ai-teries or veiiiB. 

{yXxrtvm.x^oMVV'B Akidt/pfiimsUk, Z^'ttc/i, f. fMn. Ifnl, IHSfl. VII. Ptiig. Vtirtd- 
j»hr*,. lH-,7. HI.) 

We are not to plotie too mQoh reliance upon the faihire of tho art«rinl pulse, for 
tfais sometimes oocan daring tho u^oy while the oiroulatioo Is still aotivK \ Um 



BTCN3 OF RKM, I>KATFr. 



29 



iipliT:TTnof:mpU mipbl be iipcd to give snrr-r indication* of aremaiDn nf nrtcrini oon- 

traction \)\s\%\l}'iiit K^ffft* i^f-rt'tiii. ft intmeli'it tlr tn iit'tvt rfrUf. lK*l1i| olaiinx that 
tbe emininc^ of the rirtcripB is an infnlliltk criL«riuu vl (]i>ath, «nci [.roiifise* as the 
be** loenn* of lintprminiiig this, the «xiK>«itig hik) dividing of th*.- t^-mpornl ortcry. 

It U u'cll ill »iich pti.*pg ot f<o>qt<H]t«v1 (niMi dDatb to ptnc<> a li)>:ulurc tiriiily nn a 
liuib, wIihu. if the death be renl. no turjfe*cence of the vciiw will eii>iii»> ; ftri.1 if the 
wiaa ar« thru dpunoil no lilft(xl. or only a ffw *lro[»ft. c«oapo. As rejjnpds venesection, 
it ii a rot'ans of s^cNmilarj" v:dne, ns ihe Ilow of Idood iii;i,v ;U«i cuii^e in Himiilx i-yn- 
copc. It i* wt'U in all ixuujr U> (luir f»n liir-itiirt's aftHr v«nfwctii>ij ; rfiin*iii l^ri og, 
hoirevnr, time in corp^ep the dpvelupment nf g-jw mar thvu fore; out n sinnll amonnt 
of hhxi*i. Ma(»nl"h ( yirr^^'^r'Jl Arc/iir. 18T2. Lv., p. Ill !. advises thata fln-^r .ihould 
Ui tt{;htly boimd with s thread; in appurcDi death a BliKhi. n-dmuifl aiipcon* iii tho 
whole of that pari whii*h iK hiryond tbi! thmid, while in rL-nl d<>alh no Much t-flt^ct 
cgQ«nc«. Pnnrtoros may lie mada in p;»ru wlirr« th« umall reftwU have thiti rnver- 
iixgi^ tbe HiKs or L<ing\)e. and tbe eacajre of a few »maU drops of blood U a sure (?) 
ga of appjxvnt dcdlh. 

AlnxctilAt' irntal>ilitv in excited hy !mUiting nensitive nerves ; by pow> 
erful light, !>}• Mtt-riiutatorifis, ticklinj; of tlio nos?, of the «kiii, iMiniing 
(miLxitAnI propiuiitioiis, lilUtci-s, ilrop|iinj( of hot Bt'Hling-wnx, of hut wnter, 
a|i)ilii^itiuii uf liie actual caiitL'i-y), Hjiriiikliii^; with caUl wati.'r, rubbing of 
thr'i'ntire bciily, parliciilurly i>f tlie lnick, Ui pxt'lte rt«piniU»ry itiovuiiiirMts. 
The most CKi'tain nti^aiiH conHL^fts in th** t^jCHMiination of ilip (!lf;<!trieal ^xcila* 
hiUty of tlic iniisolfM tunt norvot ; tliia disaji|H*aniig, a(:couUii;r to ivccnt 
iavtjotijpitianit^ m £ruiu oae and a balf to three houra ufu;r deatli. 

Electricity has been long known and nmed an a ineantt of textiu^ for real de^fa. 

I' -'-■ V"-Mi *-■ ''- "/tr. rvtfyirtinH Dir)t^i/..eto., ITHl. KlTK, Uettrr v. Miobn'liH, 

:! *chflinhitr ty^V'T M'n9cfifn. 171M). CKkVli, Df /nrt'ill. utita' 
\ -rtfrn. 17!)3. PoTnERoil.L, .'1 yftetnqairi/iftf'itltrSnajten- 
*inn Iff i'iUii .i■■.^^^lH, liifcl. Hf.id.uan>', X'irrrt. l*ritfHf»;fitiitt-ri tur liMimmvn'j dim 
nnlin'n Tn4^. lH't4. Htr"vf., Ifrr /?,*/r'f«'«fc-i«i(jt.'l?*l).V L-itur, Itip r(--'<carul)«H of 
BoKR, KKl.r-ti. Ul<:tiM', N*»*>*i-.. and otbern an) worthy of not*. We re f Br lastly to S. 
riUWoTI-.L, iJ^frfir'-'iir 'j.>'<-t,itfHr->u hi-mr^pif. ftfCt.. \^V\. It*J«KNTItAI, ( \Vw\. wtd, 
J'tJr' '""■' : ■■-"'I Im-. rf.-otT!!'' •■■■ ■ ".rnl-cd the fft «i'»r(<H( oleotrioal i-xcitahiUty 
of I \iM-vp-*. A rluwo rnsfiandiftl the time of iliHiipjM Mi-aooa 

of r>, - 1.. fiv. !i I If and tbrfle hoiirwaft^T death ; itdit-uppeara 

•ooncr after ubruni' iftcs. nion.* quickly ia those reduced than in 

tbe ttroDg. The ■ . . -. fnila itooncr Lhan that of tlie mtiNolea ; 

tbe orbicularis pAl|>L't^:;ii'uiii i'<:iiiuiiiK hiiigv^t fixcitable. Kven throe hnnni after 
death, wlien th« nvud Mmperatiirt! 1m stdl iW ~Z7' C. , when thn jnintjt nrn utill fl«xi- 
We. '■ ■' I'^ii" ot tvu\ dt-nth may h*" podttively mulu from the Inw of muFcnlMrand 

jier\ uility u> tbe fariidji' and galvanic currents. In a caic of hysterical 

Be*.'ii., .^ . ,. i,. th" pre>*<.TTatifin of elrctru -ratxscular ami norvous cxeiLahilily iridi* 
cat^l lifr wiii-ij hardly any other ftiyn i"if it wiw jif^reeptihlf'. RoMmthid r<ni>,iih>nt na 
err>ne(jii> the iitiKfrvaliono of Tracy anil Joaat, to the effect, tJiat in ether nleup 
and piiisooing' by carbonio oxide, the electro^musanlAT reaction in in fp«ator part or 
Wholli lout. 



Tlif* t««tjiig of the scD»ibility of the akin in not aIwH>'8 ef<rtuin, for tlirro 
art* many '.^^iwwfl of appiirt'iit dentJi in whioh rpcovery takes |iUr«i whei-f», 
owing to asphyxia, tlie fuinsibility to culaueous irritants sccuim wholly loHt, 
and th*? mtine is obsei-vnd in ctuitm of deep uarcosia produced hy clilorofonu 
[iHh<ir], hypnotism, «tc. 

A g>K}d m>;Atis of teHtiiig real death in hy aiiplying miifttard plaslni-s, or 
rubbing the skin with moiateneil flannel, or with hniRhes, tiutil the 
(rpidettnia i« destroyeti. In cases of real death tbe spot ou which lay the 
mti»tar4l does not become reil, the rubbed parts do not become moist, but 
dry, BJid appear in fram tux to twtdve houra yt'Ilowish bruwu, lnn'ny, and a 
little tr^nalncfjiU 



80 



SIGNS OF REAL DEATH. 



(Kl.roK. T}«r.uiUiaiii«r:ifionfi,Mrto mnrtis *igna,\AipKt 1R49. E. H. 'VIrhkk, Pr»~ 
TUTi'n A'^j/.i. 18.W) 

Hasmki.t (Incn cit, p. HI) citcM t>i-vonU casttH in irhicli dtiriuK' the ii»p1ivxial itogu 
of unrvouc poisoiiiiit' ttio hkiii w»* not rorUt'^nwl l>v the npplic-aliuu of irritonUi. and 
ill vthioh. nftPT the Inpse of 8<inic hnarn, when ttotufl iiniirorenient hwl Wtkea plaoo. k 
blnnh a]>pearp(l. If the octunJ cautery bo i^pliod upon a corpne. there arue outjr 
citrbunized. broM'niiib, dty. more or less bani or Icatherj' volbi; at least no vesicles 
aiiit nu iiil1an]iuat<or,r tcocijun appear MR iii the livUit; luitl in tliinie ovemiDgiy deoJ : 
this conjittnitejt CilKlsTlfios'fl UtsU Aoconling to JoiUT an<l BaprncT, th<?re are 
•ome fomifi of seeming' death in which all local njaotion fnihi to appoar undflr the 
cautery t«ii; and in moro tflwnit timei the mliabtlitj-of CiiKii»TrfoN'R (^jcpfriinont 
boa been niuch pat in doubt by the expeiimenta of Bucunkh, Enuul^ Mascusa, 
tnd others. 

The flfxor muscles overcome the pxtunsors (the armd arc tiimed inward, 
the hands bvrit, the thninh tbriiMt into the [taUn) ; tlie lower juw hangtf 
down ; t^R sphincter ani remains u[>en ; the body fUttens itself where it 
lies: all ihcDC thiiigH take place in tnio death, 

BttmKKBACn attributes great value to the flattening and wrinkling of the olun. 

The face of the oorpso usually prcsenta n pale, waxy ajipearance. The 
face is puqiliKh whmi dealii has oocnrroil from a sevei-e ditttnrliance in the 
lesiJiM' cirtMilation (strnngtilalioii, hjinjpng, suffocation, dtownin;;, sevei-e 
pnlrnmijiry atfi^citions, nsjx^cially in young iiidtvidualH). Thr farcisyfllnwiRh 
in patients who hare bad icU-nis, ••tc. People who nsiiully have red fiiees 
Bometimea preserve this color iu death. The finaer-tipa usuolly are of the 
aanu! tvilor as tiie face ; tiouietitnes thoy are faluiah iu bodies which are 
otJicrwiiie |>ale. 

The skin of the dead is wholly opaque, that of ]>crBonB apparently d»d not m. 
Thi» liMt in best Mien by holding one's owu finftrn) held close together ogoiiiht n bright 
light ; the xid^H of thu fingem appvar rciblihh Hud tmnfllucpntr. The noii-tnuiiJnitcuuy 
of thu flngcn (Ko-uallcd drnninnMopy, of Coi-LANuUEia) oumi'tinieQ fails in cbolum 
potienta, in the Hubjects of hec-tic, while It may be present iu tboee diving of dropqr* 

Diaeolorntinns, Uvoret morii*^ are purplish xpota which in general rnako 
their iippearai)C>u in from fight to twelve hoiirK aft^r d«^th ; at &i-fit ii[K>a 
depeiidfiit pcirtioas of the body, in the doirsal dccnbituB upon the back of 
thi- r<»rj).sr, upon Ihe facr, belly, and chest, if llie corpse have lain upon its 
faer:. l/atiir, with t.ho progn^ss of deoomposition, they extend over the 
whole body. They nro tht- more extensive in proportion as the blood is 
more fluid (niilTocatioa, inft-cLioufl diseases). Their color de[»euds iii>on 
the rolnr ofthH IiIockI : tlicy an^ vt^ry pale whF>n the blooil is poor in bloud- 
corpu-seUrs, bri;;ht-ivil in poisoning by carbonic oxide, bluiKli-i-ed in 
cynnosLs, i>te. BodyHliscoloiitLidaH aru by no nienns a conclusive sign of 
death : they have several times l>een seen during life in cases of asphyxia 
by chnrcoal va]tor, iu which i-ecovfiy took place; and in such com^ they 
aitj present upon the anterior as well aa iho posterior sHrfaco of the body. 
In very unaMuic and in di*o|»sifal subjects they are occasionally wholly 
abst-nt ; iji many cases (scarlet fever, typhus) they much resemble the 
petechiie seen during life. <Jccju«ioually these discoloniLions ait; very much 
like exlni^;LKulionK in cjr under the skin : au incision in the affected |iart 
aerviiig to |>revent litis n)i.st4ikf. 

The coldiicsft of the body, aJ^or nioftU, appears at a vansble time (one- 
half to twr'nty four, a mean of six to twelve lionm) after death, according 
to the t«uijiei-atnre of tho dying pemon and of surrounding media, depeud> 



BIOOR MOBTIS, 



31 



ing, for instance, tipon tho stay of the corpse in bed» or out of it, vnrying 
in (leatli from fifcziujj or drowning. En vory old and inry ynun;; [it^i-Aona, 
in thMM- who urt) exlrcinely emaciatod, and iu the HubjectM of L-hnmii- diKiraM-s, 
it a|ppL'tirK more rapidly th»n in younger and bftter-uouiishtid individimla, 
and in thtwe liavtng uotite diHt-HMVH. Jn cases of hanging, in jti?r.'<'i>nK kilh'd 
by li;chtniitg and by charcoi*! vMpoi-a, Ihin condition »«■(« in very «hjM-ly. Iu 
nuuiy forniM nf Apparent dcntli, oh well aa in a&pbyxiu fruui fi-eczitig and. 
drowning, and in the algid stage of cholera, the surfucc is cxtrcindy cold. 
( J'u/f inf'ra, on PE^'ER.) 

The eytdida are half open in death, very seldom closed, llie eyee are 
sunken and their &xv% atan<) parallel. The eyeball is lexs tirm, Ij«>cau8e 
BODie of its fiuid contents has eva^wrated, and la»cr becuuno of tho coin- 
meuceinent uf deconipusitiau. The eye i^ wholly inMenaible. Jn u few 
hunrH after death Uie ttclerotio becomes, especially if the eyelitlA are not 
cloiwd, yellou'iiih by drying; and later it Nxtina to 1>c ct>verrd with bluiah 
BppckK, particularly in Uie neigh iKirh nod of tho cornea ; it bccnnKr^ thinner 
uid allows the choroid to show through it. The cornea loses ita brilliancy 
Boon after death, and liecotntM cinndy, in part becauae tho intra-wular ten- 
sion IK diiitinished, in pari Iwcatim' of the Inoaentng and Kwolttng nf its epi- 
thelium. A niudciy appearance of the corner doee occasionally show itself 
juat bt'fore or in ilie agony. A prolonged brightueaH of the eye is observed 
in caM-H of ii/injtfrj-ia fnifniimuM^ in d*«th hy Ktriiiignlatioii, chaiiXMLl 
Tapors, atotholica, chloroform, hydrocyanic acid. The ]>upil8 are very wide 
and immuvable. 

liARcnRR yAtrhire» gtn,, Jain, iail3t daima that the cadaveric inflttratioo of 
Uie cyelttll is ao important ti-jji of dMith. It conBlsts at timt aimplj in a burelj visi- 
ble btftck spot, which exteods more and more. luually of a roand ot aval shape, sel- 
dom (rjaagnlar. It appears alwaj'« in the white of thn ern. at first in its exteruiLl, 
later in ita iatrninl lidc. Both ijKitji rxtcnd horixontnliy, beeeming; narruvur, and 
MlangUi noitr in the infcrinr i<-,Tinent of the eye. Thi« cadnveric inflttrntion of 
tlw ej* b a symptom of putrcfiiotion ; it is a tnuuiitioa state between the Hlightly 
marked. dtup)>eariuK. or already gone, ptt*t woritm rig^ldity, aial the well-kuowa 
nanlti uf piitrt'fActiea. 

The po»t marUm rigidity, CAD.wicRir bioidity, op riffiyr morti», oonKtitutca 
one of the most characteristic, thiuigh not abttnlutidy certain signn nf death. 
It oommencea in the mu-Hcloii of the lower jaw and neck, then extends to 
the trunk, to the arms, and the legs, and at last involves the internal parttf 
(the heart, vt^Ksuls, st^miach, intestines, etc.), diniintslting in the aame 
Betpjencca. It makes iU appearance «iMjner or later, according to the coui-ho 
of dratli ; moat rapidly aftA-r many gunshot wounds, after drowning in cold 
water, after tetannx, after poisoning by hydrocyanic acid, and by atrychnia, 
tktlcT hitfh ti«fr itwrtnn tenuwratuir, *.»metiuiea after typhoid fever; in gen- 
eral tenua, the sooner, on lue one hand, the more the muscular power was 
exbatihteil beforo death, so that we see after gunaliot wounds, after totani- 
fi>rm Ajiaatnit, inn.trnlar cnntractionspussinginto rigidity; on the oiher hand, 
after ptolonged muscular inactivity, as in typhoid fever. Furthermore, 
rigidity ap(ieaii» aonner and is stronger in aged )>cr8ona, in ninseularsubjectv, 
tJltr uuiny very acute difl4'ase<. Exteinal influences, for example the long 
8tar of the boily in a warm bed, especially a very high or a very low extt*nial 
temperature, have but little iiiHuouce, or none at nil, upon the rapidity or 
downnss of the ap[>earance of rif/or mortU, Usually it appears in from 
four to twelve honi-s, M'hUnn later than twenty-four hours, mri-ly in a few 
miuutni, or immediately after death, ^i^nr ninr/hr diminiahir» after it has 
lutftd iwtiuty-fuur to fort/-eight hour*, seldom earlier ; it occasionally per- 



32 



UTOOn MOBTie. 



Bialsfivc io six (layfl, as in 'iL-ath from anite pnisoiiiiig bv alcohol, mid hy 
nill■(^-benzilI(^ lu ihis voiidilinit tin* uiu^clcs — llfX<u-8 as well ms *'Xt('iiH«>rs — 
sliortuii »ri(l tbi<ki>n, just iw in contraction during life. The liinhs art*, 
owin;; to tho greuter strength of the flexoi-H, soniewluit Hexed, thi": Inwer jnw, 
if it Imve hmig tlown, is rinped ngain, so that the fnre lins mice rrnn'c a life- 
like iU4|'>eot. (.'jtdux'ei'ic i*ij|(i(tity iiivinh'K nlwi the nun-titriiit(-d miisrIttM. Tho 
rigidity of tbo uiuules of tha tfkin ia tlic cuitsc of theso^cuUcd goose>flc&l) of 
the deud. 

Acconlin^ to TARrireH (Thtrimfn/ntittn fJitlrreriquf du gt/'ht: ds FitS Hd^ht riffiiOti 
fav*f:til/iirf, otc. IMflfSi the flnit tnni«rli*H whirh BlifTen iir* tliottp which move the 
lower jnw. the mnwlM of tho lower Hmb^ tilmn^ simultiinrously, those of the neck 
oent, and Inrt t.ho«e of the upjjcr extreiuities— he the cnuse of death what It will. 

R(»w]i*rrr ( Virt'.hiitr''n .\rfMr., XI.I., |i. ."iH) ha» dcscril«il n, i-i'_fir murti* liejfinuinfj; 
diiriiitr the lai*t mimii'iiU of hfe. In i>nliii;iry «isr(t ilealh eomiilr-tfly n'luxeit Uie 
tuuim:le«, cvcu if flunntr the loet minutes of life they were sttouifly or r<*el>ly oon- 
tnicted. Ill n few rare ii:ipefi, however, the ;"»/ imirtem riijidity i^ n direct iind wid- 
dun contLiiaatiou u( living mascular L-ontincUcms. lu mcli ciines the attitude exiKt- 
iiig durintr Hfi i« prK!i<-'rvi.-(l iu death. Thin rxttvmdy sudden rijfidity in met with 
after iinnx|iKcUrd iin<l Midden iM well AH afsr^^nulnal (ieatb ; it nffect^s teloiiUed ma 
well as feeWy rontrartrd inriKoIrs ; it is not pnxlnred liy upenal wounds; hot bi'«ide« 
in ctwctf of gtinthoc wounds, this aiidden stjffiip«fl takes place »ftcr tetanus, nfter 
drowning in cold water, after tho iiijeotion ol variouB mcdirinul sultstaueeH into the 
nrtnrii**. 

The livinp- o-mtracled ronjscln w traniOucent, w>ft, contra'-'lile, and vi-ry perfertly 
eluKtio ; wht-riTJi the inn-'t'le. in n state of ;wwf nwrtrm ripdity. in op(ii)np, hnnl, iiou- 
contrartile, inpln*itic. ennily torn, and wht-n oneo furfihly strotched do*'* not n|rain 
«honen. hut remains luifL. Livinif tnuHciilar filiren cxhlhit prolmHion of the muflculnr 
snhKtaiice through laueratioiw of the finrcolvinrna ; dead otici* do noL The cotiM* of 
the )<tiffnL-i>8 'm well known to be the cari;;ulation of the mnHculnr fin1>.*tnnoc. myosin, 
which is lifpiid in life. In this coajpnlntiou a fri'ti iiuid (the wi ralletl inn ' Mk 

mignri appears; while the liviti); muNculnr lihr**, still tresh eiiong^h to r> y 

U> the itidvuui*: current. niwnyH yjelda nu idkdlitie rcaetiOD; free acid i '.:._ . il. 
without coiif^ulatiou of the mycitin, only iu very iiiucb exhatiHted iuu»clea. Myown 
Ih cofigid.iblc in conwtinfnce of cefuuition of adlux of Idood, by n tfro|frrul urc of Mi' 
C. ithe sci-called bent nudity), by BCJdn, c«pr(ria]ly carbonic aejd. The restoration 
of frCAh hlood to ripid muitcle^ does not, or don* only in thr Iea«t degree, makf them 
S|;ftin cutmctlle. hut they become dfcouipofted. In Aoluliou!) of rommon «jilt. of 
Boltpetre, «iid carboiiiite of noda (which rediwM>lve the eoiijfuhiKtd mya'-iiil riprid 
muttcii'nr fibrus a^pdii look like freith out", but renuiiu uou-excit«lil<!. If, now, urti^rijd 
blood Ix' Kupplied, the mtiicular tibret *»>(<■«• inorw bewnne fwtft und Irjuwliiei'iit, exhibit 
Bn alktibne reaotiou, uud rontmet aft^r irritation of their n^r/eK, b» well an njKm 
direct excttnUnn. 

Compsre Uie phytdolofrlcnl rcKarehCR of II.^H^^.SB, Brvcke. Dubois. KriiKR, and 
otbeni. AImii. Ai.itV:ntt, /V'if.W« KUfiili. Sept.. 1^^5I ; KcssMAtt., /V-'ff Vi«rtri}rMfhr.^ 
18W. I., p. (W; and in VirfMtp'» Arcltir, XIU., p. 2H0 ; Pki.ikaJT, BHni'iyt z. gerichtL 
M&liciiK Wi.rUb.. ibAm. 

The coDsidemtious hix)nght forward agniuttt the pomtivc meaning of 
^xwf murirm rigidity are of littln VHliie. Tlio coiifoimiling of thiK condition 
with the iniisculiir rijridity of Hi>pf*nMit df-Hlh in crtnos of frt^oy.in;;, of hyster- 
icnl iiRphyxiii with Himnltjincons entnlepsyt with totaiilc lUid eclnrnptio 
tiltnckH, iu hardly possible. Thut in nmny cmwh ripdity is not ohRprvcd is 
in part owing to it** l>eiiip; ovtrlookwl, in jwrt W-i'iiuse of its sudden nppoar- 
anco and iiiKH|>p(tHrriiice, iu pnrt beraii!te of '\\r Into bc^nniiig. It is only 
ii\ the preniAtnroly-lxtm fu'tna, iind in frozen and tliawed bodies thttt it 
Beotus really to fail. This may also be the case in poisoning by mtifib- 
ronms, in death by hydrosiilphide of carbon. 

In cbolera-cn»c» tJierc have often lioen olmetved, several houra after d^ath, more- 
tnentn of the legu, bending of the knee, raining of Ibe :irnu IDIETL, and othcta), 
ejaunlatiou of Bcmen (G . tkauock, and otbcn). 



I 



PDTEEFACnOX. 



33 



The bpcfinning of tlccompoKition (putrffHctlori) coinci*lfra with tlie ending 
of n^'ltiv. The AniiiinninciiJ products of this dccumputtiliuii tintt imulrfiliKe 
the acidity of the hiiifened muscles, and then dissolvo the niyusin. 

I'uLrefiictirjD 16 churiicterizod by tht> oMlavf lic odor, by t\iv grecnialt hntt 
of the skin, nnd Ijy i\u^ de.veIo[iiiif nt of g»8PK. TIiPKn ivheniiUHMia np[M}ar at 
» viiriitblp timt! (Ii-om a few houi-a to one week or more) after death, accm-J- 
iiig to the t4)m|>erHtutT and iiii>i.sture of the air, aocordingto cho composition 
of th(^ txMJy, the kind of ilhwKM whii'h Uillfd thf jiiitii'iit, tlie ilt*j^-c(> i>f inns* 
m\»r irriTtiliility just tiefore death ; in grmend, it occurs Koont^st in pictlioric 
ftiid fut iiiilividuais, in uewly contiiied woincti, after deatli fivtiu very acute 
I'due&sc; nioKt (tlowly iu old pL*r»oiis, in the euiaciatod, after ohroiiic dis> 
r«auu>8, ill iho!<H ilead nf alcohol iisn), etc, 

Acci.nlin^' w Bin»us-Si;iiUAKO, the pertod of eommenoemont of both riffiiiitjr ami 
putn.'f:irl.iii:i, :i.- w.-ll as thffir (Juration, are imniediati'ly related to the dogiec of 

t: ■ irritAl>ility fixitttinjr at thft moment »t Ufiath. Kverythinit thul ■]■•••■•••■'' r^ 

t of inunciilar activity before ilvjith, ik-tt-rmiiieH » rapid ilc\t i' 

(■•rU.'ii« its duration, and affects pauefafTtion in the came waj ; ■.' ■ _> ■ 

lUiiiig iliat iocivaacs muMUular activitjr acta iu jiiot the opposite wa^. ThuH it is Liiot 
lAaiwaJM huntixl to death iu an arcUo wiuter become (|uicklir ri;^d, and rapidly 
l|»atn<fy. The llefih of nv«'r-ilrivL-n cattle soon apoila after (Uau^hn-'riug-. Iti all cjuw;* 
rof deatH by cotiTTiUi(in}<, rifriilitr and di^coniiKMition Koun occur, whfithei iUnuai*e or 
OD havft caused the death. KvRiTtbing which mchauntai the »yfitRni and rtNlncRB 
Jar irritability ret-ardu putrcfactioD. (See J^Uuw^-.Sfc<^lrARU'B Vrot/itittH i^eo- 
% lSt(l.> 

The cadavfric odor is chameteristic. Tlie preoiiish color first sliows itfinlf 
npon the Ik'Hv, in the ileo-ciecal ref^ion : next in the iutereostal 8[iacoH; and 
laAt in tlio remainder of the body; follow-ing by prefui-ence the cu«rse of 
tbff veins*. J I appears in a time after deatli whieli varies according to the 
lcn)|HTatiire of tlm air to whicli the cori*ae ia expojied, and acconliu^ to the 
Ben-son ; i>n the avera^r ujiou the thir4l day, though not rurt-ly inueh hiter 
wheti the surroundirij^M are cuhl. 'J'he ncenn-eiici' of piitrefact.inii it) post- 
pfMied if the U^dy li<-s iu an atiooepheiv oontniniiig watery vapor, and at 
2\V* to *i'*^ 0. In eoloivil |K^>pK' the grei^niah color may \w nrei>L;tn/ed by 
nibbing th** e[tidermis from the belly by meann of a cloth. Thegi-ecn color 
ia in all probability duu to a combination of Uie coloring matter of tho 
blood witb tiulphnr. 

llic formation of gas boginn iu tho Intestiaes, distends the abdomen, and 
r^nay then caufto the lower bowel, tlio bladder, and even tJie titerim and 

niiuU vesicles, to ^x\tc\ their contents after tieatli. It afterward allwts 
the entirH (.kin, prndueing a raising of the epidermiH by gn'Oidali vesiclea, 

r'udavi-ric rigidity an<I putrefaction in the (ii-st place, />'«/ //(or/^rr* di»- 
( I, (lie eyo-batl changeK, thn kind of diNeaan pi-ettMling death, and 

t , in tlie aeeond place are infallible si^is of death. Although the 

Sr»1'Urtiii<-'d phenomena occur, under oi-dinary ctmditioua, aeveml, nr nuiny 
houm uft«^r death, it ia, in individual eaaea, hazardoua to make them the 
enteria of tme death aooa after ajt[»arcnt diii^aolution. 



B^des those above ennniemtcil, a g^reat many meann of ilixtinfpiii^hintf true from 
MMfiiiitig flf!-'' t--'!' *,-.■■ pTujiotiLil. Of thu»e Homu are not mure roliabhf thau thone 
■polum of ■■ compljoateil aud costly, «w>m« are really ludicrous. Huch 

ani Nawt. - . vun Hknokl's AhUwUififft (indicator that no more life \% 

prrM'ut I, MkVKu H lUwHcitr or itin^^tjtc, the Cfreuevl musiiud, etc 

OomfMifu ei!(tei:ittlly Vii. ?f.iai*r:, J>ir Uni^raehruttina dfs ik^mntodt* «m» teirJtiieAen 
Tode, Itm. V. UAfiaKLT, op, oit. GAt'>Ai,, Mart riette tt mort npparent*^ 1868. 
3 



u 



CACSEa OF DEATH. 



The rAHRES OP DEATU OTG uuiueroxis ; but the following diviaion may he 
reoogitij»d : 

Ckmjation of tb£ ciRcrt.ATiOK, through vai-ious diseases of the Iicat-t aad 
grtait veiwelB. 

Ceskatidn of iiEsriRATiON, through the action of vftrinus cautim (HufTuca- 
tion ur stranguliitioii). « 

Deficient sutritiu.v, either pnxluced by albumen {cide »»_/>«, intutitioi]), 
or by wattT (ku ctiUtMl wstur-iiiHiiition) ; the wcukjioss uf vUi age. 

KXTREUE OB LONC-CONTrNrEn ELEVATION Oil UIUINCTIOX OF THE TCMPERA- 

Tvnv. OF THE uonv, Aiul siinultaueous deticitiucy of regulatiug meauB (buru- 
iug, freezing ; muny diKeit£4.-K). 

Sevkke PiiYStcAL AKP ciiEMHAL AHEXcrEa (cnmhing, sun BtrokO) light- 
ning-hlroke, etc.)» ^liid m»iiy |Joiw>ns, some (hjiivcnl fi-um withuut, oUif ret fium 
within th(! orgHuiii'n) (biliary nciii-s, puriikjit inft'ctinn, etc.). 

Severe rsvLUHAL. impkessions {fright^ gi-it-f, et<j.). 
f Thosft oigaiis which are the instniuients uf tin- iiioBt imj)ortiiDt nctivitiM 
of lifi>, aiid U'tiiiHi'. injury numL quickly causes death, were cdIIhiI by llie oit- 
cientA fttrifj nutrf.U ; they mv. tho huai-t, lungR, and the brain, or, lu be mora 
»!xact, the luedullii uhlon^ita. Hence wre have, eajiecially for the Iftitv, 
three ditferent tnodeft of dtiith: (1) death from the bruin, culled deuth by 
a)>oplexy (as in conciiNsiMii of thu Imiiu, largi^ oxtravaSHtitJiis) ; ('2) di-atk 
fnini tlm resjiiratury organs, by HH)thyxiii. or, nuue pi-operly, by ftullbeation 
(uR by tlio breathing of iirespii-ubic gases) ; (3) death from the heart, by 
Byuco|)e (ns, for example, iu rupture of Uie hcui-t). Thesi' three modes of 
death Hehlunt, and only in sudden dpHth, occur in ])Ure fornis. UsuaUy, 
ntpfH-iiUIy in slowly produced <leath, they cotnbiue with each other in vari- 
on* wiiya : for cxauiple, interferenee with the ciivulalion alu-t-s the cou>pi>u> 
tiou of the bli.KKl, and disturiw the cireulntion in tlie eentral nervous 
system, anil thiu in ith turn iu)p(.Kle» respiriLtion, and botli together diuuni&h 
the hrarrfl activity. In individual cutH-.**, even when a wi'll-runduetrd 
autopsy is made, it is often difficult to detemiina the exact way in which 
dciith hjia befin brought about. Kven where we have the mast striking ana- 
tuiuical ehangrs it in nut eiu-y to »|MX'ify the jnmiediate eauhc of ilenlli. We 
Bee jintit-nUs die with ])nenniouiii, typhoid fever, pleiiritic exudationf^, arti- 
cular rhouumliam, ete., in whom the gross anutomieul alterations are most 
probably as developed aa in thost? cases which termiiiattt in recovery. The 
HKirbii] procesK l»y ilwlf, i.r., the intestinal lenion in typhoid fever, the 
intillnttiou of a pulntoiukry lobe, etc, doea not uRually kill. Many di^faaes 
go on to a fatal Lssue beejiuse of mei-jiiuiieal accidents, or ronipIieationK not 
to be dit^fnoi^cd. At the pre8(,'nt day the greafj-st in)porttkni.-t:< is attached 
to the auatomo-pathological condition, while tlie chemical proetwaea are 
only regarded in owes of common [foisoning, and in a few so-called consti- 
tutional diReasea. And yet tnich processes niUHt have played an fl>^tive 
part in those cases in which the autopay yioldu tlte so-called *" negative 
rosulta," 

AliJiough it IB true that we canmtt always fAV in what manner deutli 
waa brought about, yet ei'itain it is that the immense niajuiity of huuiau 
beings who die bear witliin them some wvei-e tangible lesion. Nine out of 
ten men die of dJHeaao. Even in the still liorn Ihei-e are fotind numertnis 
fcetal diseases, anfl in caseji of " death frtuu old age,^' there are usually im 
portant lesions aside from the qnuHi-nurnial alterations of orgunti producd 
by age. About aa many persona die of acute as of chronic diaeosos. In 
hoKpital patients, among whom every form of disease is met with, there ia 
ftboat 1 death In 10 oAom. Even under the most &.vorable oircunititHncee 



8UDDKN BEATH. 



85 



^iroporBoh of dnfttlitt is 1 : 30. Tlie rfUtiou of dpiitlii* in a given iM^ruKl 
of time to tliR ]H:i[)uUii<tn during tlic wnio jM>rioil) varieis so niiieli in diflot*- 
eut coiinti-ie.s thiit we hnvo 1 duuUi lu 20 or 50 ]ivi« ; diiUlrcu uid stili- 
hom tiifiitiis IwiDg included. 

The following' ate tiie ratio* in variouM countries : 

LB:i«i.AKp, 1:51. FRA:tcE, 1 : itU. 7. 

X)Oi:ftM^»v, 1 : 4fl. United Status = 46.3. 

OITM, I ; 43. ITALV. i 



Bui.AKn. 1 : 40. Gukeck, f 



1:S0. 



TrnKRT. t :ftOL 
Ui>sM. 1 : 27. 
Hatavu. 1;2<J. 
BuJiiiAV, 1 ; ao. 



' In Ijuyc diiea the moriiJi^ b groator than m the whole ooauti7 in which they 



kl>Ri»ipc^, 1 :a7.7. 
'Br»i.in, 1 :35.5. 

YttatiiK. l'ii.5. 
I I*oxDos. I :4B.7. 
[LivKKPOoi., I :J1G 1. 
f>lASOiu>TiiR. I ;34.9, 
lGi.AH.iuw. 1 : 35. 
f^DiNJiLBOK. 1 : a7.7. 

Ot:Ht.i?!, 1::I4.<(. 

pAHin. I : 47.4. 
LJ'TOSSv 1 :3*.7. 

fllCR, I :ai.4. 

r»Api.Efi, 1 : 2a. 



Bo>rK. 1 : 24.0. 

FwHiKSfril, 1 : 28. 
AMKricttnAM. 1 ::s7.(i. 

CorKNIIAGES. I : 42.2. 

Bur.«>«v-:rA. 1 :44 2. 
Atiii-:ns, 1 : aO.;i, 
GKNhVA. t :3I.3. 
ALuiEBt*. 1 : 30.7. 
ALkXAA'DiiiA, I : tri 7. 
Cairo. 1 :I2.3. 
Nkw Yokk. 1 : 80.fi. 
riltLAUHM-IIIA. 1 :38.3. 
ltRooKL\T«. 1 :34.l. 
St. LoriB, l:4«.7. 



Ctttcsno. 1 :36.1. 
ltAi.Tt.MOitE:. I ; ItO.8. 
BtiSToN. 1 ; 32.7. 
CisoiSNATi, I :4.9.fi. 
Wabiiis<!Tos, 1 : 40.0. 
KkwOiu.kans, I rSa.Z 
Sa.NTA Ffc, 1 :ri8.l. 

Prnxtriio, l:;iH.i. 

KliH.'Hu.M), 1 :»4e. 
Uo.NTItKAti, l:2li.S. 
]ti:RI.IXGTON,VT., 1 : 103.0, 

DcNVKn, I : 119.0. 

[Fnmi X. Y. IWtfd «!' HcnftTt 
lUipurt tut It-ti— Bo.) 



With the exwpltona mentioiie<I ut y. 24, niPii do not diu suddenly. Tims 
■wc distinguish wrtaiu mrMlcR of dr-uth ns vrry ritpid or sudJuu, fi-om tlio 
coniDlou d(.>utli. The v.ad of life it^jiy ^lill lie Miid to nt.t;ur faiuldfiilv, even 
when the dciitli-Rl.nijif^le hns IuhIih] severs! hoili's. What is ftR9enti«.l in the 
conoi-|iliu« of thii* mod'* of (k-iitli (mors rt/bltaiiefi, n. per afxiplexutm, in thu 
old, *yin[il4>iiitttic wnw* of Uii' woid) in tlio uiiexpectedtiess of the event rela- 
tively to the jTwious condition of the individual. The syini>toiii« of n'^uy 
loot from a few utinutes to a few houiH^ consisting oft^nonly in insensibility, 
innomniH, couvtilttitMiri, and ilifliLfuU breatlitng. A rapid death in fi'ci^uent 
in the eai-Iiwit yoAi-ttof life, is very rare fi-oni the first yeai- to ooniplete 
jmberty, then iucreaacs iii frequency mth each year of lifr up to the fiftieth, 
and ftlw> ocenrs in the nio^t ailvanced age. It is once agaiu us fiecjueni in 
xnaJeftoJitn fitinah.ii». It oiMrnrsnutin fre<pii!nt]y in tlieduy tlmu in t])eni>;ht; 
mini is mure couiiiiod in M'inttM- and spring than in other KeauouH. Snddeu 
cUjtih is more apt to tjike jilace shortly after meals, and during <icf»!ca)ii)u. 

If wc take the mass of cases of Kuilden dt-atli in the symptoinatio wuse, 
and iixpiin* what hvsiony an^ found in tlunr examination //o^t fnorto/rt, we 
iiLBV dwide the total nuuiber iuto four categorieii: 

1. Fr«-i{uently ii» iuiporinut Alterations from which the fatal re.tiilt ntij^ht 
have come are found, n( h-uKt uoue discuvi^i-Hhle with our present niean-sof 
obHervatiou. 'Hiis ifi true in many coudttion»enumenited almve, further, in 
niiuiy cm*ea of emunvHui rrrehn, of crnshinf; of the cheat or abthiiaen, in 
opt^mtiv^ or uuumal reiluctiaB uf hernia, in citscs of uvariutoniy unattended 
by tnuch loKn of hlood, and lastly, in cAHex uf death from uiruug entotionul 
duturhance. Atnuy ciises of tlaH kind aru at the present time called cuavh 
vf abock. 

2. There are lesions which may be the causn of sudden death, and which 
ftre, ill all pn^hability, develnp4;d during the shiu't agony. To this class 
bcloH<; consider able feorous etfusioii in the venliiclea of the hrain^ extreme 
funphyseauitous distcntiouof tlie Hupertieiul psrts u£ tlie lungs, unaiutiu oud 



36 SUDDEN DEATH. 

hyperseniia of the brain and the lungs. To this category also belongs, 
probably, the existence of free gas in the vascular system, without opera- 
tion, and without a trace of putrefaction. Cases of this kind are met with 
ill newly delivered women, in nursing women, in newly bom and in very 
young children, in old and in very corpulent jjcrsons. 

3. There are met with lesions which must jmsitively have produced death 
in a short time ; acute serous exudation in the air-vesicles {cedenui pulmo- 
num) ; the presentation of polypoid excrescences of the mucous membninr in 
the larynx ; foreign bodies or solid exudations impacted in the Iai*ynx ; 
entrance of air into the large veins, as may occur in operations ; lacerations 
of the heart or great vessels ; I'upture of the stomach, liver, uterus (the peri- 
tonitis following these accidents only proves fatal after several days) ; severe 
cerebi-al haemorrhage, bursting into the ventricles, or directly pressing upon 
or destroying the pons Varolii or the medulla oblongata. 

4. There are found lesions which often kill, but which have lasted a long 
while, and it is impossible to say, from the conditions present, why death 
should have occurred just at that particular time. Independently of sud- 
den deaths, we must, in this category, make the same iuterpret-atinn which 
we must often fall back upon in cases of chronic as well as many of acute 
disease. Thus we meet with a sudden end in pulmonary tuberculosis, in 
the pneumonia of the insane or of old people, in diseases of the heart, in 
aneurisms, in cerebt*al softening, and tumors of the brain ; only rarely in 
c}iolera,'typhoid fever, the acute exanthemata. 

Upon the subject of sudden death there is quite a large literatnre, both in the olden 
time (Lancisi, Dc vwrtibw aubUnneu libri duo, 1707) ; and in recent years, compare 
especially Herricu and Popp, DerploUlic/ie Tod, ltit48. 



OBKRItAL iETIOLOOT. 



37 



PART SECOND. 



GENERAL .KTIOLOGY. 

CoYnjmre tlic prcTioOBly mcntione*) work* on general |>atboIoK.T, cepeciulljr tbose of 
^r.^[*I^»JKU. flt-JMLK, Staiick. Amoug newer wotka, Kkicii, Li-hbuch ttrr aUyfttuuin 
'Wiintjiti H. nv*;*fnt, IN-1N, mid VrfnT tl'r EuturtHfif rf, MffwA^n, IHI\H ■ Stamm. jV<m- 
htfum'ts, 1«C2 ; OEtfTEni-KK, U/iitU'. itrr titrtl. S(4tliuUk, JSUTi ; J. Rankb, fjrriHtitHf/e 
J. i*fi//M. d. JUnuirJtfii, 1H*W<;.'<1 ed J. iiiiii VlKmntnT. OnimlrtM tl. I*fiji4, d, MtffuicAen^ 
1B71 ^-ll]] ^.)- Tliti tiHiuinl lilfrnlnru is iodic-nUMl in o«cb pun^apb. 

^Tiouiov, or tlie knowletlgt* of tin* ruiisps nf dijusnar, in one of tho voakest 
rha|it<!ns of i>Hiliolugy- And tlii& is Ix^ratiirn.* tJK're arc but few* diseases of 
whidU wi> kniiw a a-rtiua iiillticiut: must uf necessity liave caused them; ns 
in the awe with many ntt-chiiiiical raiisra of Hwhihp, with pai'aiiitoi*, jioisoiiH, 
otc'licint'S. Kveti in th** ft-w cu&vh in wJiich we do dt'iiTiiune the ci|iemtio)) 
of biidi nil ititlut-npf, hs in tJio caso of |iois(.iint, we reniuin ignoi-ant of the 
DAtufR of iht> NU^)Ktaiir<> priHiiiciiig the tttAult; iih in VHiiuIa and KV|'hilis. 
"We only know that pim taken from a peraon haWnj^ a (?ivon dijttaais if 
bronght in contact nith a he-iilthy person, will jirodiic*^ a niinihu- condition. 
And Btill we lmv« an yet het-n unubtK to i.Molit(H thf sjincial poimin. 

What w«- know Qb<iut the caiisul cundiiiona of inU-iiuiI diKca-ses ia not for 
Uie most |>art about canines in (he strict logicul sense of tfie word, ul)otit 
ofutMtr mtjlcitutttf, whirh «»f theiiiKelves innKt under (ill conditions pntduco a 
defiuilt' etVecl, but u* about complex eotiditinns. nn<h'r wh^iKe iiirtiiencc. with 
inotv or h-w* freqiirnry, certain di!*fras"M upiK-ar. Fnmi n strictly Kri<^ntific 
slamipuint we must tit once reject a htrge part of nieiliual a^tiulo^yr, because 
it i» nnc^'ilftiu, uinlennini»trat^.-il, only hulf true; but fmm a pructicnl point 
of virw it is of the ntmcwt ini)K)H«nee to kuoM- everytbitiK which may by 
»ny p«»ibi!ity call forth dis(.-a8e — a knowledge iud'itpeusable if we would 
avoid disease. 

From a rightly cimocired »tiolog,v l!ow« in a natural way the Propht- 

\jiXl9 of dtseasQ. There uro connet-tml with K'ti^iiogy two doctrines bearinji 

mJosc relations to one another; Hvcikni:, which teaches how to jircBovve 

BCAlth, and TuEnAFRUTH i:<, which textehen Jiow the diBeased organism or the 

diitm!4e<t organ may be reHtiir«*i] to the normal tttate. 

Every agency of nature, and evei-j- atlivity within tho body ilnelf. is n 
cnnae of dis' nsi? the mnraeiit it [tosseases or acquires the power of disturbing 
the normal eiirreut of life. Consequently, the number of cauwes of disease 
is uiiliniilod ; and we can only bring to tmr eognizanc*! the most irnportajit 
«»il moat common ones. The jyinie influences and irritation-s which are 
ecefiHMry to keep the organism in it* normal condition, may coniluee to 
norbid at-rttea by their extreme force. Tlie conception of poraiciousuess is 
therefore quite aft rcliiiive aa that of ilisi-ase. 

A number of the jieinicious influenccH which atfect the oi^nism operate 

otdy in a preparatory way, as crtw^m r^nwfff, predise'osing causes; thai is 

Jfco auj, they themAelvea cau^^e only small deviations fnjui the normal state, 

rhich, however, thecauae continuing to act, maintain a disposition to further 

t — the ba£i» of disease, or di«po/ntio ad morhtim. 



88 



BPOBmog 



Tlii.-* piT(Iis|H>sition is not a more pathological nottou, aft there is aluo a 
pliyttii J toxical predispoaition. 

That them are nnnteroiin indtviiluBl diffnronoeo with regard to the influeiico of 

various cau(ii-M«)f tliK«a««, im vurj' utrrlamlv t'MUi1>ii!'lii'<1, forwt* tKjtnLrt:1_> nev a iiutiibfrtof 
mtiD expo&ed to the action of similar morbid iollni-nc^s. exhibiting di»t!»>« in vnn.-inff 
form aiiiliutfjiaity. or even liaritig diirfrriitdiwispa. Thin w luoBt otriHiii^ iu ibe 
oa*te ol |ioiw)ns, iiarticu lorly mineral [loisouK; umDy meu become hick aftor only q few 
nioDthit' t.'xpobur'* to lend, wbilu utherH inii^' be tX)K)«c<] for iiuiof ^uars without tnif ■ 
taring. The Mimo f^rm-s tm« of Hcarlattua, nvphiliH. aud nutbiiia. 

That caution abonld be uxed in ittaLing tbla of the above-aauied dUeasea, in tthown 
b.r I ho fact that ib was fonoerlx olaimed tlmt ftoma iudivuliwlB enjoyed immtmity 
from tni>e-worm. 

Tliu prefliHpoftition to dbteaiie in a gfneral one to whicb all orpmisnia witli- 
oul cxoeplioii are subject (for oxomiid?, any liiinmn being nmy l»e cruabetl by 
a rnUing rock, *>r poisoned in an atiiu>Kpln'r« uf cjii'lmivtted liydrogeii) ; and 
it ittnlsoa special (condition (for esanipl*-, many nifii nevtrget a tniitKinutic or 
roiilagiouH iILseuKv ; uursing diildnm am M*Klom tlic MibjocU uf ojiitHtjioiis 
disenws). 

'I1i(!i't! is, furthermui'e, a crrtaia degree of BtiKroptihiUty to the various 
iiiHiiriii^esiuid irril«iit« which at'^tiiiomorleR-scoiitiuuoiihly iipontlic or^ni-tin. 
Tliifi Miseeptibility varies niiieh in dilTffciit individiialii, and under didevcnt 
cuuditioiiK. A t^o gix'at degree of »t)F.cL-]dibiltty it> citli'ul orvtliitttn ; a too 
small ilegree, toqtidity ; two coniTptiuns which cwniiut bu fui-tliirr drtinod, 
which ate oIiaeuM!, ajtd yot urpi ii id in pu usable fur tlie uccoRsitits of pi-uctice. 

Prc'dififKkmtiuri to dificnse jMitiscs into di»i-a!io propt-r by inst'iiBiblv gradu- 
liuus: such cunditiuiut nre cuIIikI tti^'kliuuiM, wtfakui-Hft, tkiiBCVptibility^ 
irritability, ThiK heighteutnl pi-cdispoRiiion is ofluu a more aerious thing 
than true di»<]a»(; ; tho subjective Kta(« Wiu^ often much bettiir after a 
throatt-nc'd disoosu tlian bi<fure it. Th« morbid disjKisilioa luay, furilier- 
luore, biilwidc* without any aulual diuoasu having devekiped frum it. It is 
Sfddoui d(«troyed by tliu occurri?.aco of ft disease ; it i» ».oro oft«ii only 
(tuH))pnded for u wliih; ; sonu'timra it is lengthened. Thlii prcdi?ii>ositiaa 
evidt'iici'K it*M;lf cliietly in purticiilar organs and sysUims, a« for cxauiple, in 
the skill, the int<>K(inal iimrous nieinbruno, the n'b|>irHtory oi-giuiK, etc. 
Itifse [Mirts, having a stiikiiir; liability to diseaj;e, art: aillt.-d yjfrfv'jt mtnortM 
rufUtfittur.. ITiL' orgiins )>t'edih[ioscd to dlse^isc iu general, or to spL'fial 
diM'asHM^ show either no ubuurmaliiy, or an anutoLiiual or histological 
a! tr rat inn. 

Whether there have becu pi-edispositiona or not, the syBtem is usually 
assailed, before the l>egiuiiiiig of a hcvitci disease, by auutticr cxtenuil iiiHu- 
encc, wliieh is known as thn jiroxiiuHti*, oocimioiml, or exciting eauHU, cauua 
prctxima. Thia consiHls t-iLher iu a ^inj^li! niorbilic iullueucc (woundBj 
shooks, poison), or in a complex group of iuBuenccs (as, for iirstauce, 
** taking cold''*). It further bopjieus tbul niiuiy di»ea»eB npiK'ar ouly after 
the nmse haa bocu acting itevcral days; nnd thai probably in thi- uwjurtty 
of atVectious caufuil influenoea are at work which escape our ubsfi'%ation. 
All tiji'M roaBuns divpoMi ua, like Isymeti, Ut eonnecc on illne-stt with miy 
coincident occ^urrcnce, without our being able exactly to detetmiiie the rela- 
tion between thu two. 

What rclatiou exists between predisposing and exciting causes is wholly 
unknown. In genenki terms they kUi nil iu an invers<; relation: that ia 
to ^ay, the strougcr the pnrdispo^ilion, the slighter the exvitiug cause 
needed to develop » disease, and rr'rc veraa-. 

if tlio predispositiuu be so strongly marked tluit diaeafie is produced by 




IXIIERITAXCE. 



39 



the operation of exciting cititties which ure of a strictly pliysiologioil 
churaL'ttT, we havo tn ilo wiili huHvi<]ii:J su8c«.*[>fil)ility or U>iosY>«itASV. 
To this clfiss bf'lnng thci iiititHnpCA of uvlii-aiia duvrlopwi aftor fitnelling of 
or fjitinj; Mi-hw bi'mt!«, iifl'_T eiiiiiig iobsli'i-s, t'lc, of hemhiche prodiictil by 
lobniTo-siiinke, of sneezing fiuiii the iiihalution of u stiinll quantity of 
ipL'ttiL'tiutibn, vie. ; pi-obahly utwi the prodii<:tiuii of hiiy-aiithma (catitrrhtis 
vvticvjt) liuficijf tho Uayuiuking tit-tt»m. 

T)>.. t.rr.4iw-...»iti(.)n todi-WMO 15 often wrongiynppreciotwl. It is cither ooufnuniled 
•itigv of t\w diMDoc it0«lf (us in the falsely iu}'Culle(l phthisical and 
41 ' ' < ' 1 >, or. whut ii more fn>r|neot. wiMi ttip vxuilini; cauMCit of diwiiuc <aa 
iu Uiti utMiitsx at the greater frcnjuency of fnictures aud of pitcamonia in mea). 

Whether there be nny of the so-called cumulative effect in the caimes of 
disciusr — that is to say, wht'ther the fix'tiuent or long-con linucd action of 
oiu* i::anm? will ultinmttrly priKliu-i; a iixu^ oxlumuvu or niuru tnlunse 
sffoctiun, CHiinnt be dctc-ntiinod nt present. 

That there is such a thin^ as resistance, or becoming habituated to 

morbiil cauai-ii, in not to bo iloiibtcd. This in most cn!rtam about ivrtain 

poivoBS, «s is shown in the case of the ai-8eiiic-oiit«r8 of Suiyennark, of 

l^»loo1io)-drinkfint, opium-eaters, workmen in h'.ntl, timoko>rR and fmuders of 

obiM^co. The Hanie is prnbably true of many contiLgions poit«nns and 

^mtnbnmtii. Among all nthor raiisofl uf fb^eaHK, tlntf in tiumt strikingly 

exem]iliti(xl by the habit of enduring ji^rcat vaiiatiunr^ of tcnipct'ature. 

Wc cannot now pro any explanRtion of this rcKirtanec power. It U partly com- 
pamlile to the iuimuiiity of ci?nritn onirnulH to llu" sicLion of certain iioivnijN, wlijuh 
[ »Tc uiorf treiituiitly vtcftatili: ami aniinul than mineral. We cwi iiiui;:iur- that either 
the mnriiiil lausu ia iiiailo harinti^Hn iinniuliiitnly ;tt tlio HiK>t wbern it in iv.ccivcil, or 
that aftf>r itM entmuca into tlM blood it is quicUjr wparated by seoroltiig urgauH llivcr, 
kiilDoy^j. 

Ckiise* of (Htiease in geupml are either intenwl or external ; in other 
word», they are such as lie iu the iudividnal| or audi as roach liim from 

WttliuuL 



L nnmjf AL cattses. 



1>UI5- 

IW!V Li..>-, ., 

ft*pfe« ftttmnin/:, ]t*&7. 



1. INUERITANCE. 

' Jtt'iirf*. 1748. IlotioEMnsT, jIW. tkhrri}. rrhl. KrtJuk' 
t.K, 1704. PlOKJlV, /> Cfivnilitv dnuA hit imit'iilie*^ 



Ohildrcn often exhibit defects or dispa.ipa which one or both of their 
parents had liefore llu-in. Iliia ftict become* coniprelicuftible whun we re- 
flect upon what takes place in the lower animals In »uch of the biwnr 
animahi aa mnltiply by tr.uisverse or lontjitudinal si'gnicritutioii, each indivi- 
dual of ttw? now generation is literally a half of an iiuUviilMiil of the preced- 
Ling gciierntton. K;icl> half must of necessity ei^ually share the iinomaUeu ol 
lff>nn "tid composition existing in the whole individunl. Ami in thoitH 
t (tai't of which after sepai-ation from the parent ijj developed into a 
iininial by the formation of new orgnnh, it is atill ojnciuvable 
|enouj;h tiiat abnonnalitieH of the original crratuie should d'/scentl to the 
■•cioiL Now it mu»t be remembered that ova and seni^u iu the higher aui- 



40 



RSIIKBITANCE. 



niaJs are nothing else than parts &e|)arat«d from the paterniil luid matcmdl 
IkxIuu), both cujitribtititig Uj tlie dev)flo|iii]ei)t of the new iHiitig. Tho fuot 
of iuheritanoe fixim tlie fatbor is niado evi-n clcarfir by new ob*K>i%iitioii, 
showing tliat Hjwirniatozoa ai-e not merely bmught iulu close conUot wiOi th« 
»^, but jienetrati' it Uirough the micropylft. Tbewe cuntuiIt-nilionH show 
tbiit the actions of nio<lifying activities may extend to the deHcendunte, and 
niuht do so ; Imt they iU* not t-xphiiii why a eerlaiit diseaM: of tbc generator 
18 reproduced m the young. 

The lutliientTe of r«xu&1 relations wiUi an imUvuluid will exert an mtluenc« 
upoD ttie nmt«Tu:d org-ariiMtn wiu<:li i,KX!:i*iii)iiallj' laaU tH-^'iiiiil ibis cuuliiivmeiit. Thorn 
am, for example, ejweR on recnrct of rj«*^<itw*i, who. after bavin; h»i children by 
wliiU; nif»n, have Itnm iniiliittnivK hi wmllnclc with nfjixHw; an well an of ch^Mreo 
dcBceuded of white pareuts. nntl bearini? traces of colorrd hlood. their mothen hftring 
previously ha<I nmlattoca b/ncirroo*. In the iloinestlc animula we niwt with inutA 
jnotp. uumf-miis niiil riu>n) Ktrikiti); iuxUujceji ut the Mtme kin<]. For i'xain)>le, a 
ftluti of |tmfi nnw tTiipn>^nnte<l hy a tuui'.ard iloj; Hiw^ not brinj; forth liat<tanl yoiing 
OQ tliat oiiu occasion, but i» uot for a long Uiue cjtpable of prtKlncin);, with a |>ure- 
bloodeil male, a truly pure-blooded pco^oy ; ber young are always a Utile Iwiieifeot. 

We ninat olwaj's recognlae vaHous conditions in inherited and congenital 
diKeases; Knch hh the inthn.'nwK ilerived fioni the father an'l mother, which 
exiRb'd btdore the act of procrealion (Iriic inhentedorcouci^pticiiial diKetiHeK); 
08 the iuQueneiM ilepeuding npnn flie (.-ondition of the parent.^ tlnnug 
generation; fui-ther, what may have bctm cxiKjrieneed by the fietns i» ut^ro 
(intm-uteKne dij:ea=ie«) ; and iafltly, what may have boon iinpi-<0)U{(>d npon the 
individual by the tanilly life, in part by the dwulling, etc., iu part by biuiilar 
habitx. by fiiniilar education, etc. 

1. 'I'hf> condition of tJin ]»ar(-ntsbefoi'e generation is offitrcat importance for 
tlie offspring. In oixiei* tlie better to i-ealizu the poKsibdity of inheritance 
uf dit'ifaHe, we »<h^inld couMder the trnb»niitted Riniilaritieii in phyniognoniy, 
color uf the iris, nitelleclual (sipiieity, wbiidi are apjiarciit either very soon 
after birth, or Utcr. Jti.st as in ene fnmity an ui]uilinc nose, and in another 
a png nofie returns, so there is inheritance i)f many nialforniatiotm, as super- 
nnnienn-y finger:*, hiiro-IipM, clt-ft-palale, |H'euliar foriiiB of ear museles, phymo- 
sis, livi»ospndia.s. F.von warts and niother-nuirka ^pignii'nt Mflius) cpcHKiomdly 
fe-appear ui the same spot in children of those having them. Among true 
diseaws, not only ai* the 8o-c*Jled constitntional diseaseH, as tuberculosis, 
nypbilis. gout, b'pra, <liubete» melllttis, the ha>niorrhagic disposition, or 
poljfiftreia, inheriled, bnt hUo mental ili^onlers, epilepsy, hypochondria, 
hypteria, and cretiniain. Ichthyosis and the lia-morrliagic disponi tion, t^igfther 
with miiny iiudfnrniattfins, Kueb us hypoKpiiiJins, show the pecidiatity of re- 
appearing only in the male deNCOndnntn : so that tbo d«ughters, tbemaelven 
fi'oe frotn the diflcawtjt, transmit tltem from gnuidfather to grandwin, to their 
own sons. C'ntaract is cs|M'cially ti-onsniissible in the female line, ttiber- 
culusid, gout, polysurctn, etc, nearly always a]»|K>ar in the children for the 
first time at the age when thette diiieasi-B are most common: for example, 
t!ie ehildrrn of pbthitiii-jil parenU remain oftfii j)erfoclly well till their twen- 
tieth or twenty-tifih year, when they br«tk down rapidly, and are, us a rnle, 
more severely alVeeted tluin are those who uetpjire tuberiMdosis; oerluinly 
njany die in the first y»'ar wilii pnlnumary ur meningeal tuberculosis. It not 
seldom bfip|ienis that at the time uf pi-oeroatiou both [Nxn^ntK np[K>fl r lienlthy, 
though one of them, issue of a ttiberciilous fjitnily, already carries the germ of 
the disease, to nsea figurative expie^sion; the children may become tubercu- 
lous. Fnrtber, the inheriUiuce if* not always of the veiy sjinie lesions. If 
Uie jiarents have become the subject.s of secondary sypliilis, their children 



difa«ii 



akM^ 



INHEKITANCE. 



41 



often tUe in tlie womb, and the f(»l,ti8 U ejected hnfore Uio end nf prognmnny m 
& |iutrefying tindy ; or tlie children dip in the Hrst ftiw wetks of life, of 6iin|d? 
Wttttiiii;; nr they Uvp, and liitcr Itt-t^oine scrofulona; or, luBtly, tUey ui thfir 
Uini hiT'inif Hvtdiililic. J>rniik<-iinpK8 in the fii(li<^r not I'urfly c.ii\iHH% niiMi- 
tj»l dw'iii"* in his dcHO'iuluiits, it inn inutU-r of comnioii uxjKsrit'uce, thntin 
idl'ivK ill wliich liuuiuiLy in )icr>-ditAiy »'c iiirot v^nlh i^.Mimjdes of the 
Ktt»t iiilt*lli^><n<.-<r, und with (!|>ili<i>tirti und iiiibuctli^a. It is ntill iiKira 
rctiiHrkiihle how often two jHTfectly healthy larents will h»vc heaUhy 
cliiJdivii nich uutforniatiuna arut defects. 

In the well-t^tnblUbcd instance nl Ki'Oy {ffi^rfpra iter Htirtin. Ifrttttrf., \ 870. 11(1. 1. , 
p. 'M\'\. tu-u bcaltliv |HtreQt4, dtrivud of bcalthv fiiinlUc^. gave \v*\u' ia fivf^ rhildreiu 
Tlip iiMftit K'M. n:,-!'.] 24 yifarw, wm 'A it. '2 lU- bi^'h. with verj* tuntill ^TtierAtivo orjfauji, 
H'itlxMil f^xmtl aMi<<-I.i1.>>. wif^ the Hiihitri^L of ct-'italpplic Attiu:ks ; llio fti-iit'iiil chiUl. ti 
son, 'i\ Ttfnn. old. Iiirpc, like th** fomuT iti n?Hpi;rl to HL-xnal di-vplupnH'iil, <kw •iiiii'lt*- 
^ninde-i nu\\ nii-'ofticvinis ; th'- thinl chilil. b jjirl ItJ yedreold, ^ feet liii;ii, tin iiiit»efile; 
ftmtlh. ti Kill nKtd 10 y<'nni. nurl the fifth, A tK>/ of 7 yeani, bulh imbeuilQi-. 
tbera BfT manjr twh e.xnm|>li:v< tm rcoonl. 

Wirtfveii iiffrft*"! with i'c':nnil(iry BTphili* liring forth wypbibficrliildnm. routr\rily, 
tlni«? (mviiij; tcTtiftfy (*yi>hiliH Iifar (nr the mewl jmrt hf-altby <-hil-lrcii, Qvi*n whi'a tbd 
di««aM« is Very wreru. Alir upta to iii'xulalc tcrtlury eypbilu fail. 

Ah offhCts to nicb liad tvsnils ilurt' urc n fi'w considerntions. Iniismnch 
as male and fouiale fluids combine for thufornuition of tiio germ, thi» ornbryo 
may bo euufttrueted iu lis vaiiuun pHrtH riftrr the fnahion of out* or tho utlier 
[Mireiit; in ho much a-<i it takes iifier tliu ftither, it Is kits tikt< lh»? tnotber, 
and vier prrtia ; ro that by it propoiidentnce from one aide the inniteure of 
thf> utlior may He countoructed. TIm^ mingling of stoek ib » lueuui uf pre- 
venting thp degt'ntTmtiou of .iiu-oi'ediiig y:eiierulion« ; whil** it. is well known 
that the iutertniirntii^ of reliitiveH tends to develop family tmita and dis- 
eoRtw to ati extreme dejjree. It is eHpeL-inlly known iu the cjise of crutiniam 
and idiocy that the man-in^' of rehited persons favors their apiM'jintnce, 
while it is prevented by nmrria;^' among pi'iwniH of diWeivnt nii:es and 
e<«Mnfri**H. Tin? Hainu ia true in a U^asier dej»ree of denf-iiiuttsm. Othtn' 
1- U' fitci* rti't! the frifjuenoy 'if sterility in related couples, ami the 

1 . II moriiility of childi*en nf such parents. And yet we meet with 

ruuiiirii..ibht nxeftptions to thHw ruinK. 

Tlio inf'i * ■' 'iviH in f(illi>wi!<l \>y <iU:T\\iVi anil ahortion on th« one 

faftDil. «nrl ■ 1 niall'ininti'Min of nil klmlMi in thu «les<:L-n<lA)itfl oa 

th* other. .. ' --. ■.. . . ,....H..ii:d over by I)r. Jlorria,* of New York, publiahud (iiu 

fulIowtDg table in ItSJC; 



Ihdatlnadllih 


funlKw. 


Cblldnta. 


ObtkiiM. 


tVlMTtlnna 
OliUdmi. 






13 

isa 

6:10 

t(i 

19 
27 

10 


71 

OSA 

167 

S8 

IS4 
81 


43 
SI30 
955 

04 

10 

31 

1 


2D 

300 

l,9::ftl 

123 

43 

l».i 

80 


40.8 




42.5 




UO.ft 


t tK . t.^ *.u\\ aont, with niece and 


05.7 
81.0 




80. M 




W.7 



Aomftlin^ Ui Vt>lMa. tlie rif^nliil and bixlily bfulth of the 3.:tt)(> iiilmhitjjntH nf Bntic 
(Loire iufi'rieuiv) \& ancHinmciuly g<io<l, althnn^h uwiug to its [orntton un u atrip of 



* TliiK tatile in by T>r Bt:ntim, of Kentucky, for the whole United Stalnis and was 
Moteil by Prof. A. W. MorrU. Morrin* paper ia in Trans, of tbo New Turk Stata 
' 1 Society, 18(17, p. 351.— Ed. 



42 



TNirKHITANCE. 



land nlmnrt ns iVilnt^il nn nn inlnnri it i« thf* nr^nR nf fre<pif>nt intcnnarrinjfps. '^Tal- 
form&tionK, nientnl diw;ftse«. klmcy. dt-'uf iniiliHni, o|>iI(?p^, etc.. are wholly absent, 
u wf^Il n» ffU-rihi}' nnd & CcailRucy to attortion. Voixin donicH thu <ivil itilliiL-iii:ft of 
ronrrioga lifttwiHiu rulativeH, if the panic!|>&ntd enjo^ i^ooil health aud b3v« n dlrang 
carmtttution. 

WiUi the qacfltion dI Uia Lnnufjiir^ of tliH |innriital cxmijition npnn tliu health, etc , 
of childrtfn. Ibero w oU>s«.-ly allied ft immber of quesrions. whi>B« solution in of the 
(preaiest pnit-iicul iin)Kirtuuee. Whicb *trx Uiu' the grfnilKT tiitlueiicc in ^<>Uf:r»tuiu * 
iV wh«L cir<.-upjKtau(>L-s is it owiuy that MimetiifHiw tho father, at oth^r ijiiiu.«' tlie 
moUK-T fxortn a prevailing iiifliK'ncc 1* Arc the diM[Ky«tli(>n^ of the fjitlu-r urnl niuther 
itiont readily tranKinittcd to the moil* or dAn;,'ht«rf(' Ar* tho iK-culiariticw hi certain 
oi]ganf) and Hy*-tern» lu the Intt^ir duvelop«d more e^pociftlly under putr-niat or matumul 
inlhicticti? Thn-^ and stmilnr qtie^tious ctto reoeivo only n partial »<.>Iutioo lit pma- 
ent. We ueed u|m>ii thew> ]>oititd obNcrt'fttiouH, nnd ex)M?rtmt>iits upon anim&ls. In 
the btveding of cnttlo it h*B htniu imivvrtaily recofrnixvd tbnt Lliw offpiiring etfjiuuiany 
tvKf tiiM«> tlie father. In tb« huinmi f-^MM-iuH, it is beliered that tlit* tn(ither'i« iiitlnuioe 
prt?v;iiK 

Furthermore, itip dp-«trftl)le to determine tho nctnal freqnency of inhorit'Ml diet^uses, 
not thf'ir ti('-r.'<*iutity. Wc frequently f-oti dwartirh aniiiuUfi or defonned liiimuu heiiigB 
^ving if«ut! Iti (icrfvctlf uartDol ofTnpriug. tii thft lauw of certjuu i^pM^inl iliiwasrB, 
itiVicroii Utsis and iiypbilis. it in on the whoTe hot seldom that the cblldr^u of (Iibi'IimmI 
pnnmtti remniu wtll. It inunt be rcnienil)ere4l that the embr^'o bos only the tcndoaoy 
to diiMTJuA, aiid that tbniatfh fuvuralilu iudutncva its dcvclopuieiit may liecoine 
uonniiL 

2. Too mucL importajico has been tittachcd to the influence of tLc acddcntal 
condition of the [mrents during jirocreatioi). Clruat stress has Wmt laid 
npon l\\Q moi»l ilisposiltouof avt't-sioii or iiidiiri^reuof, of intoxic»liou duriug 
thr> soxu:il net. It f^lioiild l)fl reri)'-iMl>«rcd tliHt at (he time of copiilHtioti the 
aemnn and ovum have been for some lime fully developed, aud oidy undfrgo 
traus|>oi-tatiun At that time. That lUdnlity, age, habituui drinking, otc., 
nlioiild cnrrt^hlH the g«rm is evident ; tin* Bint*' nf the |iarlii>-s during coitiou 
ciui havr iiiHmMiee uiH>n fertility only by heljiing ur prcvenling the contact 
of licnicn and nvuni. 

3. Duiirig inti-a -uterine life n iiuniWr of so-calk-d )n}lunt>(^d impRrfcctions 
and diwiiws ai-i^e, raused iii |mrt by ijifi-ction of the fu-lus by thw mother, 
and in part by intlopi'iidenr. fn'tal dUt'oBos. Tlte Utter nmy lt« de.signiited 
congenital diseaiMfi in coninidistim-tion to iidii-iil^d disouEtB. 

Jt bt'iug assuitteJ that the fatlier hua been la-uUhy, the child can only bo 
infected during this period by the mother, fturiiig pregnancy everjlLing 
that in tnuiHportabli) in ihn mother's bhHxl may Im) Kimed to the fivlui*. In 
this way the motliet-'s aiiK'niic state may harm the child ; syphUJa and Amall* 
j)Ox, whiom Bctirlot fever, mcnHlea, dy»untt.'ty, tT|»hoid fevor, intortnitteut 
fevei", puerperal f^vcr, even tnbet-ciilosis and cancer, nifty b« coDiiunui- i 
catcd to the ftetus. TIih ru?tn8 nmy fxperu-nw! eeveral afli-ctinnN, 6ni)dbpox, 
for example, without the mother's participation. It ih diflereut with thfl 
montdl stiito of the mother during pregQ«ncy ; it is doubtful if mental 
depiH^H-tjim, insiuiity, etc., can aflect the idreiwly formed embryo through 
the blocMl. 

In thiji uat<!jrory belonjr the no-called imprfsnion.1 of prei^ant women, whono (H>nri- 
btlily cttiiDOt. 1« omipk-tely danitrd on " jmori croiindH. Vet many of the ciiw>s cited 
ia f>npiM>rt of thin causal iiillueuce ore fu!t:d di>i>e<i8F:«i. iW. A, H\MV(iKn. tujiue>%c« 
of Mnf(.r/i«»l Afind frvr tJif Offvpriug durinn Pnynau^^ nutl Laehitinn. Jmtrn'A of 
J*»j/eft</!ogicul Mtdidae, IStly, p. 1. ) 

A great numlMfr of nuiironniitionR, particuhirly those through arreat of 
development, are refemblu to ftetal dutcaaen. The embryo has bis va.scular 
sy- t^-'ui, his own nutrition, just like an adult ; and conMMjtteully tliere ni«y 



I 



AQ8L 



43 



oecnr id bim, jiiRt as in Uit* adult, blocking i>|) of a givon vabenliir region, 
effiisionK of blmHl, uxiiilHtiimK, atropliin*, bvjuM-liiijilii**, etc. For cxaniplti, 
it Uus been Ormoustrutod by caniplfte w-iiiii of pn.'[HirRtion!4, Uiat tliu eiicir- 
ding of au cxtrt'iuily of tiiig);r» b}* liiniu of the uuibiU*:aI turd, or by tliivacl- 
lik*> fiilite-uieiiibruiies, iiihv uvi>iitiiHt« in true 8|)(>iiUiiieLiiiH uiiipiilntioti, 
Ftirrbt-i-niori', M'e meet with oicatiices, clnsurci*, «trci|ihyj (innwy, t-rf., in itio 
embryo, in parts wliii^h, in tliu bum cLiM, riiimol, tindcrgn the satiio jjnv 
«!!*('», boctttiw dtnth would |ufcpde tlieiii. Tliis IiokU good of tnuny uwl* 
fortimlimis i»f (bu brnin imd iiiHdulla obbnigHlu, of elasun'.-* (alri'-sjii*) of tlio 
ijtoiiili, tbnmt, iiiU>}ttiii»l CHiml, vXc, uf iriaiiy [lulirioiiHry (HypliiloiitiitH) Mul 
rt-nnl diwM>.fs. f 'oiitrnnly, we oPciiAioiially nhaervti in ilie fti;rus, as widl as 
iu the f^ovr'ii iudividiml, sligbt luMont;, cuu-iiug ^oiit disturbiLUcen, c^pecinlly 
if they involve undeveloped orgaiiR. For *' if the needed size fliid regular 
quality at ihn embryn-rirgaii Im^ wanting, tlie nwuking lulnlt-oi'gaii lK>cuineit 
thniiikpu or dirfeciive/* Malforinulions arising in this way are either 
siinple defects, oi* they are instances of unciited develupmeiita. Iti eitiier 
cjuw, the jwrt i-s very imperfL-ctly or not at all developed. Growth proceods 
only to a uertain point, UMiially it in inipoa>'ible to make out. a Kprnrial 
CNUAe fur the greater number tif such irudfonnntinnii. It in only rarely that 
it i.s satijifactArtly Khoa*n tluit nieclmnicul agencies (blown, etc.) have acted 
upon the fittus. MalfoiTnations have been produced expeiimentally by 
wottnding the ovuin. Tliis ithows that only a part uf lualfurnrntioiis ara 
ex[>lie»bu> by ftetui difteaHe. 

4. S<'fiiiing transniift-tioiw aro sotncLinies elaasrrd willi inheritanc<'fl, as, for 
example, many habits of walking, of movements in geupral, of handwriting; 
and aUo Hbiiot-nuvlitiew whii^h daldreu a'.njuiix' in later yeare iVoin uiwociH- 
tion wiUi ilie pnieiit^, by (lie foi'ce uf iinitatiun, Bucli av certain eccentric 
mental tniits, hy^teiia, etc. 

0. Ijistly, chibireu bf^como Kick in the ttaroo manner as their parents, 
because they ai-e Kurrounded by liiintlar external influoiices, such as nitnilar 
dwelliiiga, similar food, similar sources of infection. 

2. AUE. 

S«e QrETELET, WAPP.Krs. ZEIsixn. AIho B]iecia] treatiMR ujion the diKHaaea of 
newlv iK.m, nur»ii»tf. «nd older children. I>v Vai.i.kfx, 1>13^; I([\r?iSKl.l. asd 
EviSfMis. 1838; nit.LiKT KT Baktukz. :t(l ed. IWJI : IUes, 1844; Bouuiilt. 1S45 
and I8«W; LKOKNnitE. 184ii; Ukdnaii. US5(1, \m\ \ OKKHAni>T. I>*«1 and IMTI; 
^^^^■LMl. IH-Vi oud ISfii ; \Vi wr. 1»57 ; A. VooKl., ikl ed.. lWt7 i ftTKPrEN, 1^15- 
lMii», Stkixkr. IftTS. S<:iiKi!UKR, J}ie Ei}/rnth. d. ktmU, Orr/iitUvim-*, IMTiS. 
Work* nn diHcajx?* of old age. hy CANtcTATT, 185it; 1)CRAND-Fabi>ki>, 186& ; Oeist, 
Itm ; MtTTENIIKtMER, lyfU); CHAKCOT, 13({8. 

The |>eriods of life, or ages, are; 1. The ntrsixo ahe, from birth to the 
irruption of tirst teeth (7lh to 10th niontli) ; 2. CitiLDiiooD, from the fir»t 
teething to the Becctnd dentition; 3. Hovtiooo, or oiri.hood, from the 
aeot>jHl dentition tu puberty (I4tli tx> l.'ith year); 4. AdolkslxncB, from 
ptibi>rty to the complete development of tlio Iwdy (2l8t to 2.'Sth yeai-s) ; ft. 
E.\Bi.v HAMiouD. from the 2.'nh to Urn 4rtth year; Q. Lateb mvmiood, 
from the 4»^th to the dOth year; 7. Old aoe, from the OOlh or ijjtb yem* 
onward. 

Arcordiog to WATPJnra, in 10,000 indtviduaJit the a^fea are divided as followa : 

~to r^thyear. 1,130. 

5tb to 10th " 1.008, 
lOiii ro i.'>th " «M. 
l£tii to l>iiUi *' HI. 



20th to S-lth year, 8»7. 

a'lth t« ;t()Ui " HOit. 

WthU)4(>th '* I.:I7:J. 
40th to 50th " 1,107. 



iiOf-li to rtrtth year, 84fl, 

(HH.h ti) "Oth '■ G48. 

70th to ijOth " 2oO. 

eOth to DOth '* Htk 

Over OOlh " 5. 



44 



AGE. 



With rc«]i«ict to ago, tlioi-e nrc to W considered : 1. The proliability of 
beooiiiiut; hick; 2. The mortality »t ditFcront agos; aufl 3. 'Hir prt'tlia] nwi- 
tion to cc-rt4iiu special morbid iitat4>B. 

1. Jhl<i»itiLiTV, that is to Bay, the probability of becoming aick, is very 
gii'at ill tlie lirst week of life, gieatwtt in coriiparisiiii to that in other 
[lorioda of Ufe; it ditiunishes uUvv tlie sixth wet-k, though ix-iimjniuj; ^-at 
until i.be t-iid of the tiiAt yt;iir. Afu-i- that age it piogn-asivoly fliiiiiiiinht<a 
until tbw s44venlh or eighth year. i''roin the eighth tn the oijjlili«eiitli year 
dineim.* is onci; more more frt.'(|in'ht; it a^^iijn g<ita raivr with tht- n.»mplete 
dt^vrhipriu^nt of the iinlividlial, rr-'u^hing a Kt-ciAid uiininiuni bi-tvri*rn the 
twnuty -fourth anrl thirtieth years. From that ago to the euJ of life the 
liability to disease goes ou increaaing. 

Tho BtatUtdcn upor this puint are liabla to Neveral obieciiunK. Tn HtAtiatim tborv 
riicmld he a nimilaht.r <if caitdiliuns. a Kimilar mude of life, and «unUar occupatiaiu. 
Or, At leoKt it in uecf■M^an' tn be nci|iiainte(1 with all the dif>«aeeB of a p^iren tftm'tory. 
llsimlly, however, the maladies found in hoftijital patients are fttodied in (vmueetinn 
iriti) tiumlicra of tho populatiou ; a fnct which cx|ilaius numciouA iaticout-fMnen. 
AwonliuK to ViLLEttM^ (.'Irm. ifliyyienr, II,, p. 247>. a nialv of Uit* working l-Ium, 
ng*.'d 1><)-^]<I vears, in *\o\t i>n the av^rn^ 4 diiyit in tku j'car ; oowf 35 yeani, 4 A >I;i;« ; 
one nf 4i) jears, 5Jt rlays: one nf t") years, 7 days; one of 50 yejir*. H i dajK; i.neof 55 
years, 12 days ; one of RO years, IB dayn; one of 05 yoara. :il days; one of H7 year*, 
4S daya ; oue of 70 years, 75 daji». FEXnim {t^tiUI fariunt <rin» annufuf tnnpttM an 
freij. tt iiiuturti. mttrb. hom. adiiUL Havn., IH40) rfatea the same proi»ort.irtn for 
tiiti iMiriod frf>in the 20tb to the 80th year, thmi^'h he i\ofM nor. find that mortiility and 
the duration of Bicknei* are greater in the Piiccecdinff years — Ihoy only b^gin l<> ritm 
in old B[;c. F]::nuI':k based hii« concluMonit upon olwervntioni) made upijn the inntine 
Workmen \ Flnttnthnndtrtrkrn) uf CnpenUajten. a corps ha%iuj,' a uiiliuuy oryauira- 
tdon ; he taltirs inUi aec-onut the nidrjcrtM of ayjilulis and wound»; and wounds are 
eHpeuially liabln to occur in the most rotiust. 

2. MoitTALiTV does not bear any exact proportion to the fpe'jiiency of 
distiise; since it dpjHtnils mainly uptm the degree of danger Hitending each 
diwaae, and lliia ag.iin difft-rs :it vurii>u8 agCLS. Tlieniortalily-recm-dn of ilif- 
frreiit localiliea and atatts diUV-r even when the diAinrblng tntliienre of epi* 
deuiicA is eliiuinnted. The eKtimutioa of the nvenige dnmtion of life, or of 
probable survival at every age ia of general and practiejtl initK<rUince for 
societies, widows' |ieuaion asaociations \^\yittweiikaitgeti\y Wt' ini-iimneo 
policy, and for tho State. 

The aTcrage duration of life, calculated from mortality -taldes ithe number of year* 
whieh all the dead have att:iini-d iii added up, and the Bum divided by the uambet 
o( tho dead)u an follow)! iu different oouulcics (Che still-births being excluded). 



Avf»Tnt\ SH.IO yr«. 

Kakkinu Ml), HO " 

Pkl-w^ia 81.10 " 



8AXONT at.lOyri 

BAV.MMA Jiaiii •' 

Nktiikiu.aNds, 1(4. 7i! *• 



Esoi.AMD , Sfl 09 yra. 

' FnASCP. 4««(1 •■ 

' NoilWAY 4;t,U4 " 

rNITKD STATKS, 24.1 " 

The nnmbor nf ntlllWrtliK amonnta to 4 per oent. The causna of Rtill-birthii con- 
nst in fa-tid di.tcaMCH, as well as in diaease* and unfavorable enuditioni! of tha 
Siother beXure uud during oouliucmont. 

Tables of mortality are almost perfectly in aceord n[HJii the following 
pointa, viz,, that mortality is diKpr*>portiouat<^Iy gi-eat iu the Hrst month of 
life, that it deereases from the second month to the end of the tiret year; 
and that from tho second year it diminishia rapiilly, ivaehing a miuinmni 
between the eighth and twentieth years. Tlie death-ratii i« Mniall l^jtwevn 
the twentit^th and the forty liflh yiuira; it is uiore especially so Itetween tho 
ages of twenty-seven and forty than immediately before or aft«r. After 



AOK. ^"^" 43 

forty-five the mortality increasiia, tliou^li slowly. At the fifty.fiftli year it 
agaui reaches the proportion it has ul live years; at the seveutietli yt'ar 
that it huA at thre« years ; at thu etghtit*th year that of the Kixth luuiith ; 
from the iiiiielieth to the Dtnely-fiftii yi^ar it Hinouiits to tUv rut'j Ht l\w 
»rnxmil mouth, nitd at the oqo Luiidrciltb year it surpasseti the rate during 
the Bi^t uioutii, 

Hortiditjr-tableit (flo-oallcd life-taUlQH) ans tables which indicate Ibo dttnth-mtc o( 
a popniation ot grn*-Tati(m ; that is to wiy. mark the ordor m which » corUin jiuiuV-cr 
of jtersiiQ.' bora itiiitultiuieoiLHly, or *if pdrhnnR nt a giyen age, die from ytar tu yfnr, 
They iHiuuUy ihow the probobilit.v ff (leftth. llift order of dying, oiid the probaliility 
ot »urviTul iprulitiUc tlumlioii ul lift^f fur useh yenr of liio. FiJe example, the fol- 
hjnong iahle of murLalit^' for Uvlg:iuiiL, by <jL'ETt'.LCT. 



Aa^ 


Fopntail'in ! NmnlMr 

Idvhis. 


Douha Id latPUO. 


PnilMtdu tiiintti<Mt 
at LUk Ijtmn). 


rrutMliilltr ul IlMUk. 


n 


10,000 


1,,'SOS 


41.56 


a 1509 


I 


y,4U7 


015 


5U.58 


0.07S4 


2 


7.S83 


S90 


ni.'2S 


0.0379 


8 


7,:iat 


ISO 


rj3,80 


U.02«>ft 


4 


?,:)HT 


134 


53.75 


0.0181 


S 


T.avi 


Sti 


33.a9 


0.0]:» 


10 


e.tsui 


54 


50. lU 


a 0078 


ao 


tt.aTiO 


61 


42.37 


0.iK>gs 


vo 


fi.7»0 


61 


34.7H 


01 on 


40 


6,100 


60 


97.10 


O.OIJW 


BO 


4.401 


80 


10.73 


0.0! WJ 


so 


3.454 


114 


ia.83 


O.WCM 


70 


s.mi 


ito 


7.27 


aooeo 


80 


7.'>0 


lt«J 


4.10 


0.1373 


90 


92 


23 


2.39 


O.S-VtO 


100 


1,6 


1.6 


0.50 


i.mHK) 



Compnrr. Cami'KR, Die vithrst:fi. Lfhfin^finHrr, 1835; TOBLKIi. ITtber d. Ikae^ung 
dfr It^nJkeruHg, IS.13; QuKTEi.BT-RrKCKE. Vtiier tt. Mcwchen. ]t*^18; Glksh, 
J/«/. St'it44t. i/cfl Cii(Aar.'Jl9^Uaisj- iiZoKJkLiiS.L, AreA, f. jthifa. //<rjUum/<t, VI. ; 
OEBTEiU.KN, hot cit. 

%, Ah ngarda T'mIiK)>oH)ttou to individual discaseB, each age is liuldt; to 
CPrUin diKefl.*'8, ami thene diaeaaos run a difierout course in various periods 
of life. ThiH Ia to a great exU^nt e.\[)licii1ilu by curtaiu aiuitoinicul aud 
phyiuologioid ]»eeulinriti(» of urf,'uns, 

Tlie diHcn-vw of Uio fii'tuH hiivo already been treated of (p. 43). Those 
afft'ctioiiH whit'li i^ttse iirfiiiuturp t'xpidHion of thu ftvLus, w>-cuU«d abortion 
or pri'inutiirc labor, caunot bo couRideixul in tliiH place. 

Compare HBRAJt, Mon.Sohr.f. QeburUk., 1863, XXI. 

During labor the chihl in oxposed to pressure upon the head, belly, ura- 
hilical tiinl, and the cxtrfiniLip.s. Prt^ftHun.' upon thrj liiimd ui»y produce 
extravasutioQK of blood u[m>u and witliiu the skull ; that u])an tlie umbilioal 
cord BomL'tiuiiM produrcH death by aR)thyxia ; that upon the extremitiea fr&c- 
lurui. KvL-u without marked couipifs-sioii, tha prolonged Htay of the child 
iu thu {•euital [masa^e becomes daiigerous, aud deterinitiea luBuiorrhage in 
Um bniiii, asphyxia, dobility, lutd death. In geueral the need of breath 
{bfVoiH de renpirfr) ia uiimtl iniuiediutt^ly after birth, aud tluK explaiuit the 
often niueh-prulou|tHl apparent death. Occaaionally a too rapid dtUvery 
tnay provn iujurioua to tlie chihl, because it doe» not in that ca^i feiil uiucU 
ne*ii nf air, lujd breathes feebly. Inoculation witli gunonhoMtl virua whilo 
the child ia travfniing the geiutal passugo (gonorrheal oplithaiuiia of tho 



46 



WrRSINO AQE. 



new-honj) U not rnre; sypliilU, itt spite of Oie vemix ctMnwi, ia pocsible, if 
tUviv he ft wiiuuij in the skill, hut very rw-e. 

Ill iJiit cdiiCM^; (if llic tir^il 1V-w iht^K ufu i' birth, but more L-itf)iMUally until 
the iliir<l aojd fuurth d»iys, all cliil<Jrt*n lose wt-iglii, mui it-gnin their ori^tual 
weight only uii the seventh <lay. The jiropoittunal auioinii uf Mnod is 
Btniuler in tiie iiiiwty Uirii thiiii in the ndult, boiiig cmi>thii'tet«u<h uf ihu 
body-Wfi^hl in the hitter, oue-iiint)lotmt]i ill the former. The bluud bus u 
high specific gravity, contains bu abuntliuice of so1i<l iugTedienlHt I'sjH'ciidly 
blood-corptiBeles, mid only little libriii. The uie«n jiulse-raleduriiiy the tirnt 
"v/vtik <if life ia I'Mt per mintiU-'; the blocKl-pi-t^-siire iti lesK, and the dniuticiu 
of a blood-circuit shorter ia the ytiung than ia tlio gi-owa iudividuid. 
New-born children inspire forty-four tinien i»er iuluut«. l>tn'i»g Ihe iirut 
faouni uf life the teniporHture ninkM froiu 1° to 1.5° C, rising iu h fevr 
houra to l\'.f)° or theittabouts, where it rt^niains- 

At thi.s time the danger of illness is ver^- great. A kind of revolution 
occurs in the whole body of the child ; various organs enter for the tiret 
tinit! intii at-tioii. Conuug fixuu the uiufunuty warm mediuia cutibtttuted 
by the< amniotic Huid itiUi tlie uir. the organism is nuule to uutU-rgti the 
uiost nmrkcd uccUmatiou, a more severe one than any which he can afterward 
ex|>erieuce. If there be any altdittioim of the bearl, of the luiigu, or of the 
nervdits system, such as interfMre with the rewjuraUiry pro»va>tj they l»Tonia 
evident for the iirst time, and cause deulb al once, or dut'-rmine a rapid 
failure ul' sLreugth witli eiyinptinus of cyanosis, ur the so-catlL-d atelectiuds 
pulmonum, or produce general debility. The straight tiduili ui-iuifeti 
frequently contain dining the tiret weeks of life tli« so-cjiIIlmI uric acid 
|rfngt4; the result iu some nise8 of increased tissue uictamorphnAis ; in 
otbei-a of interruptions iu tbo 8ii[>ply of oxygen during hihor; they are 
never observed iu stiliborn childn-u. 

The division of the unibilical coixl and tlte aloughitig awuy uf it^ end 
fi'Oi^uontly are the occasion of local and geueiitl disturbances, uiubiUctd 
lueuonhugc, umbilical aiteritis and phlebitis, )>yii>wiji, ti-isiuit», tetunU8> 
liidurutiun of tlie skiu and subenuuieous oonneetive tissue is a jjeeuliar and 
sevei-o ilititsiRe uf thf nurtjitig age. The so culleil iotoruK ueonuturuiu is pro- 
duced by the e«capi' of blood-pigment into the tbwue of the skiu, which is 
very hyperiumic after birth, ami lasts from tlie niidrlle of the iir^t ULvk la 
tile end of l.lie second. At ihia ago we also, though \ery nirely, see jaim- 
dice resiilliiig fnun ifteutiou of bile, aiul as a sign of pytemia. 

Tlie pi-edij-poftiiiun to disease is so strong durin>! the tii'st yejir of life that 
one-fourth of all childrt-n Vkuu die wiihiii that [»eiiod. The gi-eater num- 
ber tif deaths occur in tlie first mouth, iu the first week, uiKin tlie first day 
after birih. Mortaliiy is greater in tliuiw first Uirii lluin in i-hildtvu born 
later; it is gi-eater, notably gn<ater, in cities thnii in the couni.ry ; greater 
in iudiiAtrlid maniifuctiiriiig districU than in agrieultunil ones; greater 
among thejHior thaniuuong thoae well-to-do; greatest in foumlling asylums. 
During gent-ral epiileuiics the <lcttth-ru1e is the greater in children, wi llwy 
ore aiiacke4l sooner after birth. The helpletis and dependent stste uf uuis- 
lings seems to have a good deal to do with this great uiort^iUty, and iu favor 
of this is the fact that illegitimate children have a much gntuter death-ruta 
than legitimate ones. 

Od the avfrnfro, to 10 per ceut. of all diildmi nrc illegitimate ; the larger number 
bi Itavsria auil Suxuuy; the smaller in Sarduiia and thu Nutiiurlatidi. In urlian and 
induMtriii] iKiuulaCious the trruinrtton ia Grnistor than in Uio ■encultuml olaai 
(14.7^7.11). 

A healthy diild, male or female, grows in lengtli by more than oue-balf 



CHtLDIIOOn. 



1 wz** fliii-iiig tiiH first two yenm ; it increiwt« from 50 cent, lo about 79 ceut, 
Tt tichlps or •juaili-ii|*li»i its wt-i^lit; tliiit is to say, It wviglm 5 lo 4 kit. at 
birlli. If) kil. in tLc fir«t yr»i'. 13 kil. in Uio HCtu^iul. Tlii? r«Ilitwiiig \h lliO 
nito of moutlily ijioreoM} in the fii^t yt;iu-, tht.' Initial weight bciug 3.25 
kU. : ■t.OO-4.7-.'i.3-fl.i»-«.5-7.00-7.4-7.tM5.2-«.5-8.7-8.9 ktl. 

Sucli »i»'ciiil Je(/>rmiaHt.inn4 <if w<<i^}it incrptww tmvo not inomly ii tlif<in«tii.*nl valtio, 
but nisi) D pratHiciil niie. Tor li}- th<?m n-e van iv< ia a (Tftrtain rniiTin<.<r i\ie ii»efulaeMi 
of n ^v«ti infHrit-Iood (tnuthcrV milk, nutsu'i milk. artillciaJ food|. 

The in-nfttion of the teeth takes pUce in the following usual order, 
though ili'viutioiix ar*j not rarely nWrveil : 

From tlie kiUi to the 7tJi innntlt, tho two lower muldln int'tRot-K. 

From lilt? $tb to tUo lOth uiouth, the two u|i)>cr uuddlu iuciMur^t, &iid LhA 
upiHir lAtentl iiiciaors. 

From the 12ili Ui the I4th moutli, the firnt four molars, aiiil two lower 
i[iciM>t-s. 

Fniin tbo 19th to 22tl nmntli, tliu four canine teeth. 

lu tht* 'M yi'iii- tho iMicond uiohirK. 

Childn'ii |>ri<Mftit nijiny (icculiariticA in or^^anixitLiou aiid niodo of reuetion 

wbic4> Imve Jin inllnt^iici! ujmn tb«' ftjitiiK; ami ext<jut of uiuthiil |irmw*u*c«. 

Most iiriking is the lijibility to spasms 0'>-'ll^'K sfia^nis). 'j'lics(«, in mildor 

I forni-t, Bticit UM ndliiig nf the i*yus, twitching of tbu nioutli, j(.'ikti>g of singlo 

ube, occur nflin- inhiuriilicant [irovocaiinii in nnrsliugii, na (liii-iug niictnri- 
L aud defecntiou. lu tbu vaiiuiis utti-ctiutu accotnjiiuiiLMl by f'evt'r, wa 
I often meet with situ^nm. Tbia abiKiruml excitubiUty is nttiibuteU to 
tthc softiifjaa, Ibe humidity, mid the rapid growth of tho braiu. This excit* 
Ability, however, shows itiself only in the motor aj)|*iii'alUh; for stMiftibility 
i& never greater in the young Umu in the oldor person; every irritation 
whi»Q jtainfulncMi ntuy be ustiniiiteil, as tlea-bitOK, itohiii^ rrupLions, inlcr- 
trigu, are more easily euilurwl by the Infant. Veiy young ehilili-en *«eem 
to jM:<s?«.'-^'i» a coni|dcte iminuiiity tn nenrHl;^u. Insanity, with tbe exci^jition 
of cmigtMiital idiuey, is most nire in (childhood. luternnttent fever and 
ty|>hoiit fever do neciir, hut more tiotdoni than in i»ersonB of riper nge. 

The unjitnniical peculiarity iliat the lar>TX is ditfeivntly pivporiionrd 
fruni tlmi of Llie adult is of ini)Mirituiee. The vocal tiKstiiv in narri>vVL'r, 
clunk like, the eartilagos are sofu-r, aud consonueully the glottis is tuore 
eaoily cloM.-d by 5{>jlsiu. The extreme wiiul of breath untl dangin* of 
asphyxia, wliit-h in the jwluli win U^ bri3ughtab(>utonly by jw-ciilhHl o'dema 
of tbe ^lotlU, will Krise in childi-en witlioul any trace of orgiiiac ilist-aae 
(fiiW- eniiip, hiryugi8[iiuti8tri<lnhi>, tusthma Milluri). The dungcr atlending 
trim ci'on[i is inufh Jncnyuw^I by ihc naiTowiie.ss of the itir-piisNages in young 
chiMien. In tbr wune way tlif narrow nusitl piis»iig<-. of tin; new-lM>ru 
shtnild be ivnietnbered, for brrciULse of tlii?i coryza iK^omxts a dangoi*oua 
maUily in tlii>^> subjceta, nursing is thcvcby rendered ditheult, und tliuir 
life is easily brought to a tunninulion by the aiuemia of iimnitiun. 

Nun<ing eliildivu vomit with the greatest enae. This arises from the 
poattion aud ttluipe of tlie Rtomaeh; it lit^n more vertieully. und ita fundus 
LI but little dovelofwd. DiHturbanceti of nutrition, probubly of » citetnical 
tM>rt, aud diarrhwa are frei]ueut. aud cause dtvith by exhauHlJon. New dan- 
g^m are t;ncounl*reil when the fn'>tl ts chan^^d or when the child is weaned. 
Thif hyporivinia of tbe month, which iweoinjianies tht: fii-st irruption of tbe 
1 i linifs iiiuses hypeneujui of the brain, aud ouuvuhdous ; uf lew coa- 
ure diiti'rbu.*a, and erythema of the skin. 

X'ht i>kia and tho mucous moiubiaucs are mora excitable, mure prous to 



48 



cniLunoop. 



diaortUii-a of circulation. Tlie fmictifHt of the I^-nnttintics i« pronmiPnT In 
chilfllKKiil, Uift i{imniity of lymph in incroitHod, tlu^ lyinphiitic glamU have 
tlnnr greaUwt (h'vclt)|imeiit ; and in tlie latter we more uft<-n nbst'rve ulUtra- 
tii>nK of nutrition than in adults (Ho-t^itUeil scrofuloiiH diHeiustrH). UaohitiH 
now l>t>}ritiM (rj nhuw it«vlf^ uHually in i\w Klmpu of sufUniug of the occi|iiuil 
bono (croniotitU's). 

Panuitf-H, Kpecially Hc« and round worniR, mailily lulgo in thnse yanng cliildreu; 
tlie fonner iKHinuRo th<iy cannot wi.-Il clean themKlves. Ttio itamu in true uF nporeA, 
tbe coasQ of thrush; aJso. i^erhapx, of iiscaiia. At any Tate, their moru fre^ineut 
ajapcoraiioe iu uliildrea U evident. Other parMilea, auch oa tape-worut, arc rarer. 

Aftiir llifl first dentition, sfvpre difmiBes of tho respirHtory oi-gans aro 
more frnqueut, such as pneumouia, ci'onp, tubei-culoBi^ of the brouchiiil 
glaiicbi, whoop lug- CO ugh. 

In the Hgi" ht'tweeii one and a half and eight years gi-ovrtb proceeds 
mpi'ily, »n<l the 04?rcbrAl funetioiiH are ilt<veK)|H-i.l. Oa the aveni}'i>, a child 
grows iu jpngth ubriiit cuiiC each year; the wf-ight of tlie body goea oa 
inoi*enKiiig to the eighth ytiir, riwng in boys to 20 kil., in girls to 11' kil. 
The bluod Im-H a lower RjMieiiio gnivity, coii^jjulalc-s (juidcer, rontninn a less 
aiiKiuiit of solid iii>{i«dieutN, hiut more i^d corpUHcles. The pulM>-iiiU> 
diminishes from 1 10 to DO beats j>pr miiuite in the eighth year ; the respira- 
tit»n-rnte fvnn 40 to 26. The ahsorption of oxygen and exhalatmn of 
carbunie aeJd »iv relatively at a niaxinmni. Ilniiger and Ihinit i-eniain 
pressing (the hnlf-year-oUl child ingests daily one-sixlh of its weight. Or 
even onetit'th, the adult only one-twentieth), and are not aa well borne as 
by adtillA. Consequently, eiuuciatiou during diseaHu ia greater. Thu 
rapidity and ext-ent of ttRsna-niotantoi-phostii in childhotKl are evidenced 
also in the comjiosition of the ui-iue; a child aged tlirec or five years 
paiutoA nmcb more in proportion to its weight than a person of about sixt^^en 
ycat»; twice or ilirioe as much urine, with twice or thrice more ure-n, luid 
inure tlian ilirico as much chloride of nodium ; the amount of phoHphatrs 
is, contrnrily {hecaiiHe of growth of honi-s), diminished. The cn]Micity for 
regenenition in greatoHt in all tissues (flkin, hones, nerves, etc.). 

l>i.Mn.HeK of tlie air-poBsages and of the hing substance aro still frequent 
atthisajje: among others whooping-cough, tnberculoaia of the broiiehial 
glands and lungs. Diftea.soH of tbe inte.^tiueA are tesft us a rule. iJaiiger 
arises from diseasen of the brain, from luhercidar mf^ningilis and acuta 
hydroeephfthis e.sp^oially ; epilepny and chorea hegin to show themselves. 
Kiichitis, tuliercular and Kim|di^ iiillHmiuatiou of thu bunen, are iho 
attiihiites of this age. ConsTitntional discii-Hes are es[»eoiftlly cornuion ; wo 
Bee, in arhiir.inn to the tuherculnsia. s.-nifuln, scarhitiiut, rubeola, variola. 
That young ehildreu should be [wiittcnhirly liable t*? tlio last two of those 
di»ea.-40S, doea not dopi'ud upon » special predis|K>-sition in infancy (adiiLla 
alfio hiive thi?<c diseases when tliL-y hA\n not had them in ohildlio^jd), but 
upon the fact tliat a human being cannot be long iu thu world without 
being expo4od to infection from both tlie^e alfectiuns. 

Fi*om this age \intil puberty, boys iucreuMC 5.6 cent, each year, reaching 
at the age of twelve years a height of 138 cent , and girls I.ir> cent., «u the 
avei-age. Boys gain about i* kil. in weight par year, girU u little more, no 
that in the twelfth year children of both aoxea weigh on the average about 
30 kil. 

Tbe state of health in this {>eriod is, rm the whole, favorable. The 
diseased which do occur in this period exhibit no pecuUaiitieh, they are 
Buch as have been euumeratod. Wo have now lo deal with the morbid 



prBEHTy A>T> MATmmr. 



49 



on8<>qtienc[<s of aitendaiicp at acliool. 'ITicjie so-called »:hool JiscaseK Imvo 
bejr origiD in luul ventilation, in bad or ut least irroguJar beating, in too 
inucli sitting, in bad borl^--uttitiulo«. Thence mny arise general annfuiiii luiil 
&eix<ruta, FtitpenibviridHiicf uf bluuiJ in Oih httuJ, of cong(>)^livo or mecliaiiical 
origin, witli lie^tdHctic, nasiil ImMnon lia^r, guiir<% Kculi^^sii^, UMiulIy with 
convexity to the right, myopia, etc. lleaidon, uttendiince at hoIiouI is inijKir- 
tirnt. becanfie of tU»! [Kibbible Kjn-trjul of infectir)Uii iliNwiwen, esinjcially inuu»leSf 
Ecitrlet fever, wbuoping-uongh, diplitltui'tu, iUv. itch, nrul lintm touuuruiis; 
and bucuuM* of the ucquisittoii of bud habits (ouaai^m, elo.). 

Coropare GciLl.ArUR, HytjiHe Mtviairr, WM. Vincnow, I'n Archttii lftK>, XLVI., 
pu 447. 

Tlio yteri(Ml from the thiiteenth to the eighteenth and twentieth years is 
called the i>Et{i(>i> oy I't'BEitTY, or developniirnt of viiility. Vouthit grow in 
this [•eriml si>me 30 cent., girls 20 cent. The inrn^aHH of weight in rviiii 
more rH|>id limn l>efoi*e, reaching /iK kil. in boyg eightL-en 3'eai-a old, and in 
girU of the snnie age 51 kil. Tlie pwlnionary capacity goes on increaaing 
until tiie twcnly-tifth year. The ijinintity of air iiuspired iw greater ihiui 
tliaC taken in by adults, so in the exjured carbfHiie acid [even doublo in 
some cHseM), and tlic exptreil wat^-ry vapor. In this period the mental 
ntlributes, exerlion.s, and character take extension, in conjmiction with 
aexual deveiojiment. The new functions of senifn-elnborationf of throwing 
off of ova and menstruation, atTjrd nuuierou8 upi>orti.)nitie8 for morbid 
action; in the female sex amenorrhira, dyHinenonhieH, ami chlorosis i*rii fr«^* 
queut, in bolhacxea there are extravagant notions, disorder of the imagiiift- 
tton amounting to positive insanity, this taking thfj form, usnally, of erotic 
or roligioUH maniji. KpilepHyj chonm, hysteria, neuralgia, are by no means 
uncomnioii. 8«>xual aberration {onanism) or sexunl ex»:e.-isea often occur, 
and weiiken the body more than they would in hiUT yeai-s. The various 
forms of V'-nt-reitl dist^nse ai-e al.so frwjueut in the latter half of this j»eriod. 
All acuto discaflPB occur in this age ; among chronic diseases tubi-rcidosis ia 
particularly frequent. 

From tliH twuntietli to the twenty-fifth year, until the period of complete 
growth, the bones and nmaoles and the thorax e»peciallv develop ; the 
thymutt gland dinduiitheK in size. The pulmonary (vital) capacity still iii- 
orrafles. In the twenty-fifth year IIih nmie is KiX cent, in height and weighs 
03 kil., the female is 15' cent, high and weiglm .^S kil. All .neverc acute 
diMfusoa occur in this age. In pUco of the laryngeal atTcctious notice^] at 
JU1 earlier age, we have more often a'dema of the. glottis. In females 
chlorosiw is still fKiment. Uodily and mental etfortB are well eudunrd, and 
sexual in<lnlg(iucc is |^>crnii8Aible if the bmly be well di^vetoped. 

M.iTiiiK \r.E cxtondft in malijH a year or more bt^yond forty years, in 
females almost to forty years: this is the period of highest developments 
The male atuuutt in llie fortieth y^iir hits ntaxitnuni weight, (i^.i) kil., and 
then bi-gins to lose (li-.sli. Women continue to grow heavit'c {reaching to 
a>>out .'iii kil.) until the tifticth year. This is the healthiest period, pixj- 
vided tbiit there have not been greiit exertions, excesHca, or ill U"-^idtli in the 
jircceding youth. At this time gout ap|>eaiM, and with it gaKtric and hepulic 
AtTeetions, hn-mnrrhoiilal eonditinna ; in women leucuri'ha'ii and other diit- 
cwtes of the sexual organs. Kxertitum anil privatioiu are well borne in this 
(wrioil, and evnu exceR.^s are not as harmfid as iu previous yeais. 

The nam»> of rr.iXAi-TF.Rir aur, that in which ilectine bt^gina, ia given to 
the [•(•riod indudod between foi-ty-five and sixty in men, and forty to forty- 
five or fiflv in women. Jft-n bccoiut; murv curjnduut, women rapidly grow 
4 



60 



CLtMACrERlC AND OLD AGE. 



older; in hoib the size of the body rtiniiniBhcs. Mcnatniation coascs in 
litis peiind, with ccpnconiitaiit dismdeift, nnU tlie duvclnptnent of dJMiiKes 
of the intornal sexuiil orgHiiR and the Itrensts. Acuti' di»[*]iw-& aie tiion.> nirv, 
but mort! eamly |irnduct^ deatli. AlHji>iniiia] iidipOKo duptrsit occurs, fgpcci- 
ally in inei), thongli witliout morbid HClion. lastly, wclind curcinuiim in all 
orgmis, prcwtatic niid vesicnl diKcuscs api>ej»r, r» well U8 cnipbysfiim and 
iLHtbuiii, iind wrebrul Iin'inDrrbuge. 

Oi.T> AUE, at It-uAi to the Hp; of M'ventyf is rhnracturizcd hy diiniinition of 
mitrition ; tbo so-called vitj-ni^mun «pniVr«. Witliin ibis are a Dumber uf aim- 
tuiiiicni and funclional alt^mtiona; *^ sr /ileitis ipsa vior bun.** The wasting 
of old agi* con»iKtu in dimiiititidii of ibe cunue<:live tlKSiif, in attttpby of Uie 
ftkin and in-»i-lv all inmxms nu'inbranftt, as well as of tho mnu-ular stiuc- 
tiiit-a, oxen Ihow «jf tbc Intf-rnal <ii-j,fniiH, gbind-diiclM, and bloodvessels; in 
gmilmd diniinittion of the excitability and energy of the nenoiiB Ryaicm in 
genei-ftl. The blyod exi«ls in smaller amount, i» pCKirer in solida, |>ariirii- 
lurly in blffod-corputtcles and aJbumcb. The large >d oik! vessels ai-e en- 
larged beraii*^ of htss of the elasticity of their middle coat ; many ai-ti;ricK 
exliibit deposits upon their inner coat ; anuuiber of capUlaric^are blocke<l up. 
Through loss of teeth, eoiae imincroua alterations of the org;ins of re^pii-a- 
tion and digiiKtion, a1n*phy itf Mooti and Ivnijdiatie glandn ; di^^tion, blood- 
making, and re»pii-Rtioii ai-e inipaii-ed ; reApii'ation even more bv dupoKit of 
pigment, by atrophy uf pnlmonary hdmh-.s {f-mj>hift,nna jtrullr), by sbikiug 
in of the vert<-bnir, imd by ossiHeation of the costal cartilagf-s. Tlie respir- 
atory niovemenln an? more frcHiiient hut mon* shullov. The abttorptiuii of 
Oxygen and exhalution of catUnnit? acid are leiw in aged porwinw. The 
aiuoimt of iitiiic, us well as of its solid jjigredients. is diminished. The 
lindy t^miperaturu, utniiige to say, is a little higher than in adult agt*. Tlie 
alisolnle amount of heat, however, is ItH8» and ho is the power of iTB^isting 
cold. The broiu umlergm's a marked degree of atrophy, the ri-siilting space 
bt-ing filled uj) in ]'art by thiekeninp of the meninges, in ]>art by accumula- 
tion of Henim in the ventricles; yet the senile brain dropsy is not the esaen- 
tial ftttnbutft of thiH jteriod of life ; thcif are usually ol)«erved only slub>x»ni- 
neas and imbecility in certain linea of thought. The bones become more 
fragile in consequence of increase in their medullai-y subatanctt. 

All lliH above are in a meoaiiro uoruial events, and the aged seldom die 
of tbeni. iXlmoat alwaya there are found in the bo<ly well tJeveloia-d new 
aiiatouiiewl lesions, vrhieli have, however, given riw to but ill-Klelijied 
syinplonis during life. To this cate^^orv belong many vascular and cerebral 
diwases, pneumonias, cancer in various orgnus. Nearly all chronic ailectiuus 
are still comnMHi ; among acute ones, ty)dioid fever very M-ldom occurs, the 
acute exanthemata not at all. ( Mfle i/i/ru, senile uianumiia.) 

3. SEX. 

Compare thfi )it«!Tatnr» of dt»eascH of trade* by IlAHAKMxr. 1700 ; PxTtMiiKn. 
1R33; ViLLRKMf:. 1810; Fi cm*. CAsrKR. Cucss. Hai.foht. 18^5 ; Biuk'Kuann. 
}Ki\ ; etc. The liti'tnturt- of ftsiualt! disenws hj OMASOKn. 1H20 ; HlKnoT n, 1S21 ; 
J.iRO. I Sill ; Mknhk. 1KJ1-»J; Lkk, 1H.«{ ; C<il.nMUAT. IKiS ; FhiNkiJ.. 1H;»; 
Brwn. lS:»)-4-*; Mi-isw^Ka, 1842; Muhf.n. 1843; Kiwiwh. I.Si", 8d ed. in l«l ; 
GH.U1AM. li^.')0; Joxss. 1850: Scxxzost, ISiW ; VEit, iWi* ; Thomas, 1874. The 
literature o( uiidwifery. 

The iiillnenci.'i of sexim! ditVereuce upon dia^aao aiiSL^ from the original 
and physiological diftereiices between man and woman, la the latl^M' tJicre 
iieing less toughness and density of all tho tiisauca; less development of 
the bones, of the atnated and smooth muscles, of the external skin, and pet^ 
haps also of mucous membitmes ; lesser size of the digestive ajipcu'atus and 



ri 



8KX. 



tgrpnt glanits, k& well aa of the kidneys; putiitively ax wt^ll an rt^lutively 
ttsMit* iiipiamoqihoftw*, Kinatler ueeil of f<Hi(i ; less tlevclopwiciit of tim 
rt'^s[>ii"Ht<iry nppHratiiH ; siimllfr vital cu|it«.-ity uf tli(i lungK; Ninalkx foima- 
tiou uf curlji-mif houI; leKii jtor^itirHtian ; » Muiillor umount of Itlood, pur- 
tirnlarly of bliKHi*cor|iU8cIu's as well as of filn-iii, a givuter projiortion of 
WBt«r. Mtlttf, atul ulbuiuim ; smaller voUimc and w<figlit of tW brtuii ; givftttr 
firtty ilf|K»Hit» etc. 

AgHiii, xhf two stfxes show different rraults iu conKCqticnce of difft-Tetieea 
ill uiudc of life Hiid edticiition. It \h sitflioieiit to reinemlM;r tbiit men are 

riiKit'H KtibjrcL to nil tboHH <iis«>nfutn wliirb itiv 4^|>('ciiiIIy or Kdlely nitiMid by 
unfuvfimble by[;i*fnie roinliiioiis, or wbii-h iin* of meUfomloj^ical ori;^in, 
Hiicli a-s pufiHuunta, [lubtiomuy i*tti|>liYstMiin, ItecLitKllKciiM*, luid uiticubii* 
tliuumutism ; uttd to sttrli utTL'ttioim hk nn* eaiiMMl by occu|mlioiiit uiid pro- 
lionx; and butly to n!i'all tbf ffllciu-y ol' kucI) atuiieK uf iltHfiise ait tliu 

r of ulcoliut niul lobiictTi. 
On the f'jutiMry, woiuvn 6tid moTu oft.en exciting c-ansos of ctiMeusBe iii 
eduiTation and uustotiis. Nervous irritability, hyiitvriit, and spinal irriltilioii 
Uttve tbi'ir orij^iii in tbe aVw*iice uf iMaclita! activity afier whicb follows 
biralthy fitti^ui*, iit actual iiinnci'aiou in th<} conti<ni[>lat,ion of tlio stat'^ of 
oiit-'s VmhIv, iu exciutioii of th<i »i.'xu:*l ftiijMTitt,' witb-Mit 0[ii»ii'ttiiiity f«ir ita 
gmlificiLtioii ; woiuou of the higher cIrhkhs are especially liable to tbet»o dia- 
euacii. Tbc prnponileraiic« of this morbid grouii in women ia «o very great 
that tlie alxivu cauiial i»^udttioii» arn not Kuflicii^nt to nccotitit fur the dtapro- 
iwrtion : and this is particularly true of hynterii-al KpaMtns of all kindii, whiuli 

■ arc very aetdom iiiet with in men. In Uuk question thure probably enters 

■BOme jti unknown piwuliarity in or|:anizution. 

TIi»»se affei'iinns of the liriiin. spinal coi-d. and n'^rves, whieli are more 
e^peciullv produceil by directly aetinj; morbid iuflueuceH, are not more 
fretjiieut amoti^ wonteii th<ui men. As roj^ards insanity, the ^taxistics of 
variouH (Toontrich kIiow an exc^s aometinies of malex aometitneit of ffniah>a ; 
the liiittT 18 the caafj whero wtmieii take niort- pail in tht; oeciipatioiiH, eiires, 
and fiuutioiis of Uiim, a** in France. In ihe malt* wx ulniost lliu only »[•»»- 
iLiiHlic affeeiio'is olwerverl iiri' i']«ilepsy and teinhUH; umong WLrm^u eptle|iHy 
is not ;w frtijucnt, tetanus is v>-ry rari% t)ii i|i«) cuiitraj-y, rellex dpa^sniK of 
all kitidM are very ciMiiinon in wumi-ii. I'aralyses are, in compan»i»n with 
females, very fivquent in nuih-s. Dinbetes mellitua, gout^ loeomotor iituxia 
are rery mncli more common in men than in women. That vesical diseaaea 
■md voKical ealenli ahonld l>e more common amon^ men may la- account*-il 
for by the sti-uctun* of the urinary organs. Women seldom suffer from 
hiemuri hoids, which fact may po&sibly be uonnected with the periodic losa of 
blood at meuKtruul periods ; yet they, contrarily, often have stnima. 

The gppftter frequency nf (lisonw in female fastnMMi in hm yet of mikiiowii cmifcitJon, 
Ott«> feami tlwt amoni; 4*11 eiwB of innlformutien in whirli the sex eoulil tte deter- 
mhtMl, Uiort? wwre 270 r«mtLlcM and 30;; iiiiiIi^m Oii thf i-nnlTary. the au-enlled tnins- 
poMitiou of ert'aus ta much more couniiuu in ui«u llian in women. 

In all conntriefl there nre mora boya bom than girla (in the proportion 
of lOiV-l'W; to MWl) ; thf number of l>«)yK HtJlI born is greater than that of 
girls (14 : I('). Tliut lu«t eireutnHfanee is probably due to the fact that on 
the aveni^e the Ltody of the mature mah^ fietuit ia larger and heavier tbun 
that of the female fuitu^, and that, consequently, there nix' greater inipedi- 
Ineritx to the birth of lK>y»f. Oreater mortal ily prevails among boys after 
hlrTh, Bo lliat if we ret^kon one-year-old ohildntn the pn^poudeiouce of males 
is quite obliterated. This proportion continues throughout life, eo that 



5fl 



ssx. 



almost witliout exeoption women outminib<^r men (102.7: 100). Fium tlie 
Bccoiul year to puburiy tluTe nix< tiu nmrkcil JKfunMK.'uH in the ili»t>nHeH uf 
the two HUXU8, Rxcfpt diut ixjyn ui-v tiioir liiible to liir^rngful cn)U|>, uutl that 
luter uu giiOfi are more often the subjt-ctH of ohorea. During the period of 
puberty the fi^mule Bex exhibits lunrt* atfections of the sexual organs ibau 
males. This is explicable [mrtly by their pealer size, Uiii'ereJit ItK.-atiuu, 
rsjiecially rfdnplicatiima of pi^ritoneum, partly by their more complicated 
structnr*;, aiul pui-tly by tKoir irrej^'ular |K!rfuntiauce of fiinctioti. Anaiuia 
of Uevflopmeiit (cblorositi) Is eapeL-ially the attribute of Uie feuiide hex. 
During vtiuth botli aexes share acute tliseaiies about etpially; ainuiijj; men 
pulmonary and pIiMiral inthitniuatiouH are more UKiial, in wiunen tlioite of thu 
jieritoneum a little more freijuont. Those dan^rs to which wonu-n arc 
exposed during jiregnancy, confinement, imd lying in, by ati'cctiuna of the 
sexual organs and the breaiiUt, are counterbalauced in meu by bodily and 
mental Btrains, to whicli Uiey are expound in their occupatiuna. Amoug 
chronic ditieo-scs tlio^o of the <lig(rslive orgatus, auch aa colic, tilccr of the 
stomach, caimtiiMitiou, aa ^Cell us diM»iseH of vciiiif, are mon« common lu Hie 
female uex. Hiose iliseaKeK which abHolulely catian the greatest nuirtaltty, 
such aa tuboixulobis and canctir, are ttl>uut ei^jually divided between the 
two sexeji. 

In all diseasea women endure better than men. Bevero |iain, great loaa 
of blood, continued ill-health, exhaubt nu-u quicker than women. Aa 
regards Llieir relations with p)iytiiciaiit>, Muuien, uHide fiom tlie iiiBulierabltt 
pranks of hyKteiicat onoH, are mon^ patit^nt, traoUiblo, and llmnkful than mtto. 

The mortality ratio of both mxm is iiulia8t«il in the foUowing table of QtTB- 

TIU.ET. 

Oot of 10,000 indiTidoak there mmrlra— 



AT Ttis nto or 



IX cimn. 


m TSI OOOITTST. 


8. IMG 


rSHAUtt. 


HALU. 


FKMtEJ*. 


0.1» 


8,030 


o.stn 


s.ano 


B.01tf 


8.6<H 


8.088 


»M\ 


B.7fl0 


8.470 


8.830 


8.1D5 


8.G41 


8.3U 


8,004 ■ 


8.0IE9 


8.M0 


8,1h7 


8.587 1 


7,»rtl 


6,47» 


8.078 


8.400 ■ 


7,43« 


7,083 


7,575 


8.001 


A.fl26 


7.170 


0,030 


7.330 


6.104 


6.7fll 


fl,fi»7 


0.031 


5,011 


6.477 


6,326 


fl.Wl 


B,7H9 


e.ao.'i 


0.109 


0.538 


^U3l 


(i,17tt 


0.0:J8 


0.3115 


9,4»l 


0.036 


r>.80*i 


<i.215 


&,884 


S.OIR 


5.734 


0.083 


s,e4i 


5.733 


5.608 


0.790 


fi.038 


0.A00 


5,343 


0.484 


4.085 


4.881 


4,573 


4.813 


3,744 


4,S0H 


4.13+ 


4.113 


3,110 


3M3 


3.588 


3.458 


».7a9 


8.225 


3.194 


3.118 


S.HSS 


S.WI3 


8,707 


3,703 


1.869 


3.807 


3.377 


3.310 


1,373 


I.HIU 


1,713 


1,758 


BPl 


l,2(M 


1,1U 


1,188 


A9» 


083 


5tUI 


010 


184 


380 


339 


303 


40 


80 


67 


71 


ft 


18 


14 


18 





1 


1 


1 



COSSTITtTION, ETC. 



S3 



4. C0K8TITCTIOK— HABIT — TKUrSBAMBlTr. 

By cowsTiTUTioK is meiuit a sort of pbysiologieal baius^ a |)redispOH)tion, 
prnseritin^ itrii'lf as ROiuetliing oonstADt in thu tuim<- iiittiviiliml, lind <')iiirac- 
tfrii«il by tli« iiiuclc of reiictitm of nrrveu niid uiiiscles, ai»l aJso by 
tlie e<mj|iosition of the blood and by tnitiiiioii, as well lut by Um [powfr 
of rwiiHtaiic*! to e.\U>rtuiI and intfnial inJlucnccs. Tliciw: ccuiditiani* 
8'jm<*tLtitt!s |H;n<iHt witboiit riiatige diinug (lie iiidividuurH wbole life, 
mid wMU»;tiiiiKa aiv alUrr^l by ciiiuigp of cnjiditirinii nf life {tiutrition, dwell- 
ing, I'rtlltiij;, etc.), or by dweasen. By habiti's (habit) we ttiidt.'i-htAi)d the 
nxteninl tfxpre?tNiun nf the rouNtituttoii ; tbrao uie nduted, iix art; thi; group 
of syniptniiit) T4> intoriinl con<)tiinii8 of diw<flMe. The torm tkmcek.vment is 
ajiplii^l Ut Minu^liini; special in the roiixtitiition, as, furcxaniple, the humors 
or frame of mind, and the mode of luaiiifestatiou of the activity of the 
brmin. 

The vnrions forma of consittntion He id part in the domain of hcaltliy 
]iff*» and in pAJ*t correspond U* morbid fitatea, ur ahaflr into rnorhid crmjttitu- 
tiouB. They are as little derived fruiu nature, aiid aa little detined aa 
are foniis uf dia>--iLiie. Tlii*re are as niuny canKtitiitiontmaliumiin U*iiig.s, jtist 
&4 there are hh many cliMeiLSHit an sick people. Hut, aa we net uji certain defi- 
nite forrn«( of dineatte foi* the sake of description, so we pick out the moat 
dintinct ty|>«« of ronHtttntion. 

1. TiiK ptTnn5<; on noBirsr rnNSTiTtrTioir. The body is Urirer, or of 
mediiitn i>iw, bruadly built, the skeleton and mUKoIea are htrongly formed ; 
1h«- [iiihie i^ full, calm, and not variablr, ttti< bloixl rich in blo<jd-curpnai.^le8^ 
there are raix;, doRji, n*s|dnitory roovrracnta, with gi*eat vital capacity, 
abundant pcrapinttiou, coucentratetl urine, good digestion and nutrition ; 
the fntictiuHH of the brniii are not too much tieveloped. 'Hiis constitutiou 
ia Kcldoni met with in women, n(>vt.'r in yniitha, only in men betM'oeu twenty 
and fifty years uf a^e, most fi-fN|ucnIly in thoMj cin.swfs who enjoy good 
fixal, t()gether with physical exercise. 

Bome woaM wparntft from the ritwve the pi.ETHonir rossTlTimoic ■ oharacterizMl 
b; a more <!Atii[>a«t. hrottib>r buJli], Bbundaot tnoAcular hatwtaiice, red chookii, Ups, 
and tnncoiu mombraam ; iin<t<tcn moreineDts, sometime* a abort UMsk. 

As ■ttrihnt4-« nf this f-onstilntion are favorable conditions of health ; 
pvAt power of reaiKtanefl to the actiuu of external and internal intliiene*w; 
rapid recuperation ; fnspicnt acute diseatwti : pueuuioniu, rheumatism, 
typhoid fever; among clu'ouic diaeases: cardiac (Gseanes, gout, pulmonary 
etnphyM'ina ; tuberiMiIoHia «idy when there i» an here<litary tJiint. 

"2. TiiK iRKiTARLK co}tsTlTtrrio!«t the most common, capeciHlly lu women 
and childien. 

Tb*' clianicl*rs. nf ibia constitution are, snuill muscular develo[inieiit, a 
fiale and not over well nouriiiiifd akin, marked ilcveltipment of the inttdlec- 
tual faculiiea, lively tumperanu'nt. 

Tbf rollimtup flabilivixiimH may hv maile The CONSTlTlTTton wrtn CKKKnUAI. 
IKIUTMUMTY, iM rxiKt» ill nuch iiiibvidualB asejufilf become deliriouH in fevpt ; that 
witb >-l'l> M. iKKri'AKti.rrY. iu:iii tbone who easilr have coDTutfiions; the ('ATAKkUaL 
C"'>»Trm i(i>', in which thin? in a dry. etislly nuiistonttt, ur llabl'V ckin, with evitlent 
tcuilvticy tuiutonhul iiillaiuitnLttnu ; the WEAK-AN.EMic rcMrriTt'TloN, with |>nle 
aktu Mild uiiiMtuH inmi>l)ranrM, umall mitw:bt>i, cxhAUKtion quickly m>luccd. TIk! 
iui.t0('» iMNKTITl'tntN tut|flit be milled U\ thid ItHt, a frequent one in Kiathcm ciiuu- 
tzlea, ahowini; a dark i>r ^cUow akin, dark iridva, a Uvelj and oft«n sofferixii; glance. 



4 



54 



OABIT ANU TKMPKUAMKA'T. 



3. TiTE isnoLEXT rofTBTlTnTios : Miirketl I>y slow devoloinnciit, »l(»w 
and not nbiiniluiit nioVfiiiE'iits, iiiHc uf fuiigitu ; tUv boiifs, fnt, autl {jlunijii 
more Uevclo|>eU thtui tli« uuiwles uiid luM-vt-t*. Tlie skiu is Inutix'tcHS hiiJ 
«tiff: recovery i« siow. As sulHlivisiona wo Imvu the venous, l^uij^batic, 
luithenic, and cretiimiii eoiwTitiitions. 

It U to a T«ry grcnt cjttent au error to asauine ibnt the variou* countitutiaiw ttre-j 
OinpMe to ct-Ttoiu dwf-aficfi. Thurc arc diff«:rt-ncM:H am n;gaiil tlic cunnH of difwuMaJ 
the ubtuiqitinn of t-xntlntJoiif^ for «xninpl«. whiuh in slower in the ittdolt-iit ronBtila^ 
tion. For U)c>ra)i(,-iirint( tlio matt4>r U aU[> of n ucrtuin importiuice, eiiioe. for ttX(U)l]>]a, 
inrlividnoln uf indolent (Mni)ititTit.ion. and mnny of the irritttb)e couHtitution, do nut 
well bour bloodlettiuKr luid, in genera), auj deUlitauiif,' tiicuns or muthoda. 

The UABtT ia umde up of the aize and wtiglit of tlie body, iU d<^fc«^ of 
futue^H ; alKt) iu ]turt uf tliu form aiid color of extvninl pnriA, Uio biiiriug 
of the [>ody, the tnigcsct'iioe of oi-gAnH, 

It i» unly with n^;;iu-(] to alrjo uml wingbt of the body in m»n. ainl iu 
some few anitnuiN, that aeverid important physiolo;n(iil and [uiThologiml 
cbtLniuteridtics are known. Thf extreme l>o<ly-weights in projioi-tionaToIy 
grown arlulls ur« as 1:2^11; Ihoso of heigbt an* »» 1:1^1^. Th« 
pulKu is slower in Iar{»e men then in finiall men o( the wirne nge. or in othHr 
wordftf the length of the pulse-brat iuci'ciLies with the body-length. The 
tiuio reipiired for the comjiletion of circulation incitaM'H (in aniuiuls) with 
the wtMgbt and h?iigth of (he iiidivitlind. (trowu |n?i-MiiriK of ithort KUtiii-o 
havf! u much great<-r amount uf blood relatively to their body-weight than 
tall individuals. Large nit-n have larger lungs, a larger larynx, otr. Tli« 
vitiil ciipaeity iiicrt-M>ii-H in men at tlio rale of about ijO f. eeni. for ettch 1 
ci;nt. in Inighi. Bnuill men brealhe <)fteijer, though !»s» deeply, tlmn largo 
ones. I'he )t:lative (to body weight) amount of the producla of rc^ipi ration 
i& larger m small men than in tall ones. The ahsoluto tis&ue-metnnior|>hosi8 
in gi-eater in tall and heavy jji-rnontf, while their relative amount ia in just 
reversed |n\)[H>rtiuii. Willi resjicct iu the deposit of fnt there ai-e also i-er 
tain data worth n-inemheiing. l^au inJindualu have on the uvenige n 
givaler appetite, and absolutely and i-elatively (to boily-weight) more intense 
t-iasuei'hanges than fat |»c-rsoiiK. Tlie latNtr bavt- relatively h-na bhxMl ; ihejr 
coUKiitue lesK oxygen, and luive a HUiallur juilnionary vital cHpticiLy ; they 
secrete Vks bile, umoh Ii-sh lymphaLie fluid, and but Utile mine. 

The Influenctj of thene various forms of habit upon di»*^nin> in gc<neral, 
upon its coui-Bi', tix-atiueut, etc., cannot Ije brietly rnlated. We know llial 
fat, though otlierwiw healthy persons, n*aist but feebly many nvorbid inltfr- 
nal and external influi'neea, i!i«t tlu'v ar-e more often the subject of many 
forms of cardiac, hepatic, aud renal disease, and that iliey do not well bear 
euergeiic therapeutic interference, 

Couipax« VrKBOKUT, Grandrut* d. PftyaitA>gi6 d. Maacheu, lS7l, p. 553. 

BciddeR the use of the word habit in the sense above defined, the term 
is often applia^nl to umrkeil alterations of th»' oiMiatitution, '»i- to th»* lOtt^trniU 
evidenctM uf latent morbid aelion. Tims we speak of the phthiNicjil habit, 
the otrcinoiuatous and apoplectic habits, etc., without mcaiitDg to say that 
jihthifiifl or cancer is actually present. 

With respect to TKMi'KUAMEsr, great elfortK have Wen made to connect 
its various t\'pea with given diwasj-s. Hut the coiuH'ption of a tem|H'ra- 
ment is very vague, aud tut noon aa the phy»ioiau alteiupLs to bring it out 
iu ita nmtr-rinl niatiifeatatious. it fades into the definition of coiUktitution. 

From B vety ancieot period the dirinoa into l>lll,liOMATtc. rnot.cnrc, SAKOoncB, 
and MELAMCUOLIC tomperamaaUi la recqguLwd. The oiiginaU of these atv met with. 



KXTKRMAL CAUSES OF m^i£ABE. 



6S 



IwttaoM of MTsrnl other types which hnrc been denned in more recent tlmtw. 
_jqiiicit or plllosmstic t^mpi-iamcnt Oiprr orfl a llabbjr eUilo of the mniM'tilnr 
nn dnn"*' ri^iM-.i*«. want of eoprj^y in the involniitiiry ioubcIg«, tiirycsccncc of the 
tiwiic. It »Ii 'o odijMMo (IrtiKMJt. ^mall or slow renction to |>ij'cl)ie excitaiion, 

£ Alif^hllv d- ihaiook. innall Miuihilil^ to iMilllr Butrtrfu^. lu tbc- cboli-'rie iviii' 

Ijienunent wu UitU mcUvc cotitractions of tbo vuluulury luuscU'fi, prixliiriu^ » U;ii>!e. 
babU of b(>.ly. gr«at itritabiHiy, witb force mul in-rj-utieuue of tlie irritation. 
fstronp* pftjisiftOH. The wainfiiiin' u-tniwratoHnt is chamclHri^wl liy niarkfil irritatniily. 
■ADtl riuiUly (TTt-'iit liiibilitv .if Ihv nwrvntw »iyi*l«*m to L>xlmii'<tinii. »-ii(i(U'n chanpun in thu 
|Activit> uf ttit< B{>cctiti senses and in humor, thene cliau^oji tK-iiij; producotl bj bo<ttly 
■ •xeruoua aH well un after mental ex<.>rtion and emotiouiU excitniuc-iit In tlw melao- 
lobobc fir HruliniciiLal t(;iii|>«:rutu(:iit tbrn.- aru fiiiiiid uiiilt-il aU|fbl irritabilily wibh 
Iktud? (lapaciry for r*'actiii){ ut M^UKOi-y exeiutiniin, anil f^raal ptmtsteuue of the 
^ftnnif "f fiiirrfl, (•Jtiieciallr thiit of dnlm-Js* or Hullf^tintim. 

It '- ' timt difTprctict- of t«>inpcrAment may hare n certain infliinnce tipoa 

the ooufM of <titt>.'UMe!i, c'-^|iL'c-iiilly tbo jMyuhicol ; no »uoh liilluouco hiM 

beiA ii<;iii-jii.ti.iuuxl att afluutuig tfoinalic UiacaHea. 

Wlictlicr the coxi'LKXioN (brunetto or blontli:) can att'ect UisvAtte is nut 
known. The notion that btunde wuiiien suHur more from It^ucon-bma in h 
luetY' |H>pulHi* |irejiii.lict>. On tliu cuiitrur^, it woiilJ 8uem that cancer uf t)iei 
utoi'tix i-* itioro fit^iirnt in bniin'ttra. 

AYitli r<.'s|>e<-t to UArE, tho extrouit* ausccptibility of npgrf)t'B to diw-'iiw.* 
baft always bei>u mutntiiiuecL In geoorul iWm quesliuu la cutuiilicateU by 
tiie interffrunce of climatic and iivgionic caustm. 



IL EXTERNAL CAUSES. 



1. ATMospnenic xsrtUELNCBa 

A« ATMOfiPnKRK? PiiESfurRK. Atiiionplienc presstire is a tJiti^iblt* ph©- 
nouiRiiou, Vft oiiu wliii^h it is diiticnit tn apjin-ciatp in ita inllnom-i' upon tlift 
IkmJt, becatuse it M-l'.luinuct« aloni>. Thore arc twu important factoru nnitiil 
iu attnospbfric pit^sure cluuigcs; t)w <piHiitity of oxypt'ii in thi<niriJiiniuibbi-» 
in Hi^unl viilumcM with the larcfiicLiou uf air, ibu Iohh of |>uraj>irablo nuibonal 
iiien-as«« with the i^arcfaction. 

The effect** <»f iucrcttKi>d tttinanpheric picftHure have long boen kno1l^rn to 
clivers; in more rpcent tiriirs iIii*hh Imvi* l»i>cii monj ai-cnnitHly Rtndied during 
the Imildlni^ of britl^ott by tliu pueitmatic nicLhod, and in itiHtitntiitnit where 
conipn-ssetl tiir Una been put to ihprupoi)ti>ciil urt<^ (the st» oill''d batlis in 
compivsHed air — pneiinniiif^ inHtitiiiinns). In thfs** conilitioDH thcr** oivum ii 
taonifiiUu'y (liKtnrbanre uf theeipiilibriiini of giiHt*B in the favitich in thotran- 
aitiuii fn>iiia li<;;ht4'r to a denxerair. This is niadu UKott fivcpumlly and moat 
painfully I'vident in the air by a fifpn-ssiuii of tbo tyin|>an\nn. MoviMiionts 
of df^jfluliliuii w|i)(d) upfn thf KtiKlnchian tuljes, um well wi attempted ex[ii- 
niion with olottrd month atnl mist; (VhIwiUVk cxprriinent »i:i calb'd) tHpiaU 
ixe tbri iittiiohplHTic prcflKDce on boch side-s of the tynipununi. Severe nnd 
in |mrt dan};eroitH loanifeistatiouH attend vi-i-y enddeu diminution of bigK 
atmoHpherie pressure, elfccts prolnibly f^xpliruble by the iucronae of blmiil* 
presMun^ ami by the forniutiun uf eiubolic atup|iugtttt in vaaeular ai^iua by air 
wKicb hnH Hnddonly beou set free from the blood ami htk^ mingled with the 
circulation. Theue art; uervuuit pauia, bypurawLlietiia, mubUuUr woukuutis, 
■oinetiuMfs crttivnlKJonK^ etc. 

Simitar phenonieiin Appear in unnaturally dcnae air, a» in breathing air 
too rich in oxygen. With respirator)* movements of eijual extent in iiuch 
air there oceurs a greater degree of oxidatioD and carbon -excretion tkau 



56 



ATsmBrnEBic jyTJ.rfVsCK. 



vhili? breathing mi'lcr usual atmosplieric [ursfiiire. There can be no qncstion, 
probably, as to the aftt-rH^ffucts of a stay in sucli air u[M»n liie uheniistry of 
the rt^piratioa. Bn-athing in a luit-itumtiu ojijutrittus uiiconKciuii»lv mid 
involuntarily i« done witli uion' diNteniled hings tbiin luiiler onlinaiy air pres- 
eiiif, and this (tkio lowei***'] [K>Hition of tli« dii>plii-agnt) is to bo (^xplainml hj 
thi' couii>n?SRinn of the int<wtiiml ga»*s, Tlic iwijiii-atoiy niovt-niniU are 
deep*>r and less rapid (tion]titiiiie& reduced one-balf). The Aitcria] blood- 

f>rcsaure dfcrcaspK ; the ptilec become*i fuller and usually slower ; tlte capil- 
arie» are c<inti*actrd ; the tenipei'aliire vhfu. The cuianeous aud puUuoiiury 
exhaliilintui arediniiulshed, the urinnrv Rocreliou im iuei-ensed aeeuiding to 
Boine nulliuritiett. di.'crt*a»ed according to others; the appetite ia p-eatcr; 
tJie botly-weight iueretutes. Tiie nuhiettive sensations ex|KTienCT'd during a 
loiig-conlinued ntay in coniprwwed air ait doKCriWd an nearly alwiiys iigroe- 
able. AIuKculnr movmuentii are more naaily perfurined; speech is impcdMl ; 
dyttpnira is often subdued. 

Cominre ViteJtOT, Znr Keantn. d. rhyw'L Wtrk. v. rf. fflrrutp. Anv^H. tt t^rdit^M, 
Lu/r, 1H6«. I'.vsLM (Arr/,. d^r Pftf/wU.. 1WJ8. 1, 3, «. 3 fl). A. H. BMrrH. ISf«U 
vj lii'jh Atmonph. J'rauiure, Brooklyn, 187y, autl others. 

The effects of diniLni8hc<l attDosplioric pressure have been obaorved ou 
H large scale at high elevations; although there ore Hii[>ci'addcd the iiiHu- 
eiice of eold and of varioiia oH'uil^ which must affect (he result. ]^x|w- 
rieiiee in the Alps, tlie Ilinialayas, and c-speciiilly in the Andes of Suulh 
America agree lu that healthy persfiun feel nothing uuuatuial at a height of 
ft.CMM) to 7,IHH] fn^'t. It is only wh.-n aneU^vatitm i/f 1>,(KK) to 1H,(»(>0 fe«t, 
vhi-rn lln; atinoKphore is one half lighlrr, is ri:ache<l, thai ^hurtne.ss o( hreath, 
acceU^ratiuu of the pulse, rti]iid cxtmu-stion, and a ix-niarkuble inununily lo 
the efli'cts of alcohol are observed ; these together with weaknesH, headache, 
syncope, blettding from the gnniM, nose. etc. 

New-coinent upon those elevaieil parts of the Andea snffur from "^juko," 
or " norocho^^ an nocliiuatiou diaease, characterized by piercing chilUiien, 
Iieadacbe. aud natisea. 

Tile same syniptoina are olmerved in tJioae who go up in balloona. 

Sompin<lmdHiil*»reBUt thceffectaof tarofnction of the olmoBphcn.', Tbo«cronam» 
Green mid IJiwh nwende*! to an elevation of 27.000 feet, with a tjiirometor vtariiliDg 
at 10. il2 : the fir*t 1 1,000 ■feet hariu-f been troTersed In sicTen niinul«H. Yet ilicy 
ex[)on(>noe<I iiKithiir ncxM^lcriiLiiH) of the jmliw nor (^aickened rv-Hpirnt4(iii, not evan 
whtrii tliuv uxurled thoDiselvtss in Ihruwiug out luUloat. tiU&ianKU aLtaiaed a huigbt 
o( 33,tH10 (eet. 

The redncAR and swelling of the iikin, the occaaional ha!morrhages from the 
skin and front ex[ioK4>d mueons inenihranei!, iiii> eafy of explanation. The 
same ia true of the I'lU'ly outward bulging <if the lynipanniu, with i-ar-ai-ho 
and hardnew; of hfnriiig. The chapping atid cracking of tlie hkin, and the 
CMnF,e(|U<.*ut uleeralious, are dependent upon the eti-existenl dryness of the 
air. The htna of turg^'scence iu tlie lineaments of the face, the fliminutionof 
perHpiratory and urinary seereiiona, and the increase of tlncHt may \h* also 
referred to the same cause. The drowsiness, headache, and vt-rtigo aro 
probably owing to cerebral anaemia. The w».'uknenj> ih in part exjilained by 
the diminished tirmiti'Ds in the lixnti<in of heailn of laiufs in their aorkets, 
partjcnhirly iit tlie Kliontder<joint, ns^ n-i;ll as hy the mrefactitm of the intcft- 
tiinil ga»t>s which iui[nniri' njioii the diaphragm ; the fihorl.neB>i and ijulckm^a 
of brt-athing by tiie complete distention of the lungs; the iurrease of tba 
Iwarl'a action by the removal of preasure from the bloodvesaela. 



TEMPKHATTRE. 



5T 



ITndHr t.hp«p (HrrnmitanM* wtatnulirtory phrnnmpna tAinw Ihpnumlv*'* in the sick. 
One would ftupiKuM* that the rcloaxc! of the thorax (from the UNital pn'Ktnno would 
o|wn»t" fiivoniblj ufwu tin- ptiliuuiurv irirfuJatioD. mtiklup: it ni«r»; ncuvu, iiiu] thnt. 
ct>tuir<|ii»Mitjy, c^iil'i'miliiriuiUi-iitt* would di'i'ive l>eiiefil from u rvKidt'titxi iu lii|;li l<»cid- 
ittr*. This in iodiT-d what ouctim in iiiatiy du^FW, uidepoudeiiUy vt tlii.- Iiii^l tlint 
ttilx-HMilu-is ilora net occur opon hij;h niDiintmnn. Then we have the exf«rii^nce 
vi'uli C'liiipTCHned air, which uAe<I in iiimiiiiall; heavy amounts (3-3 atmoApheroa) liaa 
di^ito i;i>i>d U> luaoy hnviti); iljapniun ; uiiil which wheu employed a^Ntemationlly 
hn>* much impruved cmphystiiuaUfua and tuburcuioiui lung& 

If, uovj the naoftt extreme rarefnction nf ttie atmosphere has Uttle or uo 
elTfCt upciit s«iii)e person!!, if a iliniumti'oi of ^eveval iiichcfl nf |tre»>ii)rr is 
wtrll l»L>riie Viv inuuiiliiiii tiuM^llot'ij, it is md [rf>riniKKiblc U> oimrliulu thui vu< 
nHiiouA ill uTuiospIierir prKhsiiie, (K^CitiTiiij: in uliu locnlitv iiti<l iiininiiiliii); 
t(i li r<!W litif.s ur <iim ittid n )inlf iiivlieti nf iiiurcurv In nat* or Tall, cuii huvc itny 
ijii]K)i-tiii)t ctiect upon ht-nlttiy j)i.-rs<tns. It may be tutid that it is not ho niticli 
extr*:rTK! chimgcs, ati pcnuancn'ly high or low biii-omctric pichsur*;, wbicli 
givra a |>articnttjir btoitip lu t)u< epidcniir LHinHtitiitiuii ; uiul yuL uiaii be- 
cottWA \ery uA^ily accUiimtized in the Iiigh i-egioiiK. Tciliaps it in oiJj 
tbe fru(|ut^cy of vnnatiaiift which in iujuriutts. 

Thi? M.-atily empirical rtatiNtica^ invf-f^ti^tiouii on Ihio (mint have yioldvd rvsulta 
of d'julitfnl iiJne. Aucunhn^; to CafTKR, niormlity in<?rcjiiti>« with tbe atiiitMpln.'no 
»i*nii««. This in true itnly ni Iti-rhn, ur at nil event* t)r«>«leu. iiinl a few yrtir? in 
Parfii, btit uot at nil in llamltiir};. wbero ii high liaromctrlu ]_<tei>-uie in muru fnvi.iritblc 
life tb^Lii a low onn. U would tue^.-iii th.-it (xtii-utiiptiv(»!i die in noLabljf dinnller 
timhcr in Berlin during high hummctric preMnire than during a Inw nne. [n New 
tork (olj«'r\"ntiouii i-xtcuding oT«r thrun yearn) if. nppenrn thiit pulmonary and ute- 
'rlbe bttmorrhugbti utuially coincide with a falling baromeCier (Guslim, lu CuhmL 
JilArwA., 1H4J1. jt. IW). 

VrVare eiitibled to obsni've tbe rffectsof iliiiiiMisheil pregjiure upon limited 
ports of ibt* t>ody during the appHentioii of ii cup. Under it bhxjd lucuum- 
latiTA^ ami iu coueie'^tience uf n.'Uttively ittcniUKti piviuiure round ubuul, exu- 
i!-iii"n* and e\tnivm«ttions lake plitit*. Niitui-ally we (.-auiiol c^mt'Iude from 
tlr -'- altomtioiM of eitnilibriuni at, to the enuHfjuenceK of giun-'iiilly ttitniti- 
i-slifd attiuittpht't'ic pressure, b«>cauKi! tli^ |*p>hrture iH mpidly ei^uitUzeU in all 
th« o|K'n oa^itieil of the body, and the possible variations are not very 
ttt lUid hiiddei). 



B. The TKurEUATrRK, The efTerts nf temperature ii|>on the rtrRanisin are 
eille-r I'n.*sil, or general. The i-csults vary neconlisg lo the kind of tem- 
]>erbtuiv (heat ur cold). Hci'oiHling to the ilurution of ii4) uction, iiud nuronl- 
iiig to tlie variationH (»o-cHlIed chilling) of temperature. In the medium 
teuiperatuna the degree of iuuring is of iiupurtaiice. 

(a.) The mk'AI. ErPKors ok tempekatl'HE, The varinuH pxlremea of 
heat and cold which affect certain \mviH of the bealy, e4t|KM'ialIy the ext4Ti(al 
tiltin and the mnenus tnembranefi, cuu.m* voriotiB disorders nf circtiUtinii, 
nrticulurly niin'mia and hypern-niitL, hiter different foiintt and i)i*gre>'K of 
uflfiinnuilioo, and at lii»t (theBo-called liighest gratle of hurtling imd fi-t-ivJiig) 
jign-ne (c*»nipare ihis proe^Rs). After extensive biirnH of the iskin the 
Dpenittire of the ^niv sinks by sevei'al dogii.'ea, and docs »o bet-nuse les- 
rneti I'hinli'ity of the arteiicB produces a dilatation of bIoodvewteI» and 
Dcii'rtS'"! rrtdintioii. Anoth«fr consetpieiice of this dilatation ih ilimiiintion 
of 1.' lire. These phenomena are frequently followed by death. 

Con- : -ly Urge congelations of the akin do not come under our 

obwrvatLoa. 



58 



TEMPKKATURR. 



Wkrtiikim ( WhcJietihl d. GtadL tL Witnfr Aerztf. 180$. lHo. 13» obmrvcd Id ca8ei~ 
of burnfl nu«lc opoii the cheat and abdoiuinni wall!] of dogs dy uicum of ufU:D rtificat- 
ed ftCututiiujtrH with tur|i«utiue. a oonotant, (li-Kiiite aiiAbutniuiiJ cbatig'e in th*? hU>od. 
Venom" blood drawn from the auttiiul a f«w iiiiuutf^a uftt-r the Imming Hhowrd, 
bestiltw tht' tiDriiiiU coii.'>tilUL'ul«. u Ti:r>' lurj^o niitii)i*T of ruutidt^ bodiix measuring 
.001 to .(MM mm., hut-ing vetymtich iheiippti^iraiiec nf round blood -corpiivclefc, Tbeix 
nmnhiT i« soiuotimcA as great oh, aad t-rn^ (;rfstcr l.han ie timt of the oorimil r«;d eor- 
puscles. and tho Iftrg^T tho more spvere the huniirii?, but lhi.'y aru iU*ay.H more na- 
mi;roitH thnti in normal blood : — he abto tuiw nnraniouti icd corpiinclus, npinu-uully in tb« 
act, ot »<P4;iiiP:itAti^iri luul from which tint rtlxivc di^MTilifd i^triiiiHrlcH hml inoft likvlj 
dunvi'd, — m:in.v wtiit« nvWvi (leni^ntij-tPMi whnuB iiuuilivr was not mrtly <.-qnnltii that of 
the red corpuhden. And tlii* expdtimcntwr lind already discovered uftcr burns that 
the twinperalnre of the subcutaaeoua connective tissue just under the pflrt buniod 
reached oO -70' C. immediately nftf-r Uie (freatvht burning, and he idsu constuntlj 
found mt'Iauiiic in tnulL-ciilar luid flaky Htatca alonj; the cupillar; tphhrIh in tlie ftMma 
of injury- : — and, 1]u>Uy, liu always made tmt Brlghl'a di««aiie of the kidneyn after 
death. 

The canse of death after extensive bums is, iM»x>rdiot{ to manj' authoritir.-*, rapid 
Inanitioii ; accurdin^' to otbern. colla).w« (shovk). eto. ; aocordiu^ to Fai.k ( Virchoit'* 
Ar^ir, lt^7l, Bd. LIII. p. 27), it oomtiitk iu ponUjrsuof the hearty which ia itaelf 
th« result of flu«peiided tonujinf UloudTeiwU. 

The hITpc'Ia uf differejit tumpernturuK nptm cells, moh an it mav be nhMttrrrd in 
livinff nnimulx, and by tliu ane uf t\ui mirro«i»i[« and hfAtin); nppanitns ^tbe so-cnlled 
noiitt cbiirnber). will be htndicil fanhiT on. Iji an incrensed tnmpenitiire nvrvcA and 
mu^trii exhibit SI) iiicrenee iu irritability and conf-ractilitT, ollliougb faithcr on lat 
40 -TtO G. in man) thiK in fullouxtl by \osg of vitality. Iilood-oorpU)iult«, ^rlundulor 
oell*, etc., aafTer in the name way. 

/J. The 0E5ERA1. KKPECTS OF TEMrERATiRE. Wlicii tlicrc IS prolouged 

cxjKlRUiv Ui A Inw ti;in|)<trHtiitT>, Kuch hk jirrtfilen tlnftUi by ftcezitig (in otir 
own regions, but esjiycially dui-ing voyagos ii» Uio arctio coiintiifK), there 
are noted diuiinution of tbe ciesiiie and poshibility of moving, fulluwecl by 
innliilir.y Ln movo, diiliiHStt nf tlit> HPitsivi uihI the lutellpct^ stupidity, irro- 
6i>itiblc incLiiuilion tu Mle4>|i, iinouuficioimnt-Rs, u.u>l netiial dioatL Tlic imme- 
diate cause ui* all these phrnomenu i& proljably iiUH-'iuia of tha braio. 

Wai.tiiek tVireUic'9 Are/tic, XXV., p. 414; /Jtriia. Centralhitttt, I8W, No. 51, 
and IHti,*), No 25 1 \ia» perfonnrd cxjicriracntH upon the inOnrncc of cold, placing the 
aninml" in a tin box, which thvy cnmi>let<;ly lillt-d, and which box wa« m holly eur- 
rouud»-d by a frwMtiojj mixture of ice and nalt — th«^ he.id of tho nnimiil Iwiny allowed 
to project IhtoDKb a smnll opening in tbe box. An animal, onolcd to IM or SO C.^ 
and Ihui pluced in u medium uf tbe hukio decree of hoat a& thnt proper to the animal, 
waa nut able to recover iiji nortnal tumpomturc iBkiHNAiit), Ix^ohm. etc.. 185DI. If 
the animal waa expowwl in a oliyhlly (■.iKli-.r nu'dium. aft, for exajuplo, to ordinary air 
ii'miHTntnrfi. it lipnnmp ronlpr and rnnlfr. and ultinitjlely died. If the animal waa 
taken out of th<^ tin box it wiui uiiabU> to Mtiiiid tipon il^c feet, but lay niati'>Tib-w upon 
i\a didc, Nuverthelcwi, volnuiaiy molinn. lellex uiOTcment', and senaihility per- 
siatod. The heart-beat* became very few — reduced to IH-aOiKu-minut*?. 'iTie respi- 
ration whiilly remind, or lierami! very rapid. tluttiKb imjHirfect. All t.bo excrt-li<»na 
wen> MHHpenilpd. nH]>eoially Um urinary. The crvature'H fyca remained witlf-ly \t\»'\\. 
A detlutte df ifTce of animal heat, at wbieh th<- funcrinnn of the non'ou* and nniM'uI.tr 
nyisleiiiM cciL-swl, ci.idd not lie made out ; di'ath biUinp place undrr vnri ■ in- 

oiani.-cs at different dejEreed of body-beat- Aninjiil*. wbich die«l or were i. i .,' 

the process of rcfii(f4-r»tion, exhibited a cou»tjiut byperajmia of tbe binp^, .13 

exudation in tbe i>aruncbyma and bronrhi. In wbite mbbitu, wbieb di^-d by froeuiig, 
Waltber Raw the fundus of the eye Iiecome (piit*^ pide jitHt Irtffure death ; thun fol- 
lowed convnlsiims and death. The author explains thi* pbonomenou by auw^nia of 
the nerxouti onntre* uonsequont upon the diminished heart'a antion. It*^frigrrat«d 
auimulj* luny he rtnUired to tbe normal de-gree of heat by artificial heatinjr to ;(ll C. ; 
by artilicial rtfMpinI.iim, only wben. bowHv«r, tbi> tunipcniture of the «un\»undiufi idr 
ia not more Mkiu 'i or ^' G. lowur tliau Utu juirnial hefit of tbe animal. The means 
by which thr- onjianinm is overuomo in the wmllict with approachinj; tcfriji;e ration 
(hcBt-iTianitiou ) are, oontroction of tbe tiMaes and capillariw iu the (miHirficia] jiart^ 
of ibe body, and by the dinunution of the frequency of oordLao oootractiouA- ~ 



4 



TEMPERATUEE. 



59 



During tlin prolougod notion of an elevat&d teiDpemtut-c^ tlio ftkiu fiivt 
ltei:uin''» w»iin^ iu«»iat, uiiJ liiU^r coveretl with u proftiau Kwuut ; the ivs|iLra- 
tioiift l>eci.itjii< tiuicker^ lh« |ml)M* in Miiallcr utid aMrnliMiiti'tl. I^^hn* iIk^ sub- 
jv^ctiTf r*-otiii|{ Mf heiit becoiiit'K tiitin^ unci iiunn i-^tivciv? nml tnon^ (lisu;^n.tvulile, 
till' ski)) bi'ooni^^s tivy, and lieuduche iiii|>i'rveiie.s. With jiocuIult aym|iio[U8 
ilcutii then easueb (sun-sti-oku or httut-strukf.*, i>u culled), 

Aocordin^ to FuitursR, Blaodkn, undotbeni, the following nymptoini bare been 
obmrtud in iiitrn cxpffncd to a tvioperaturA of 100' C. uid over : Ihe »ki)i is uiuch 
redileiiral. the {Htrspiratiuti x* increnfcd. the pulse beoomos more frtrquent, iiiid tlie 
teroperatiiru itwclf hw;* hy I' or 3 (iioine 3' or 3 . if the air iti overcliarRvd with 
WAtor)^ TApor. mn in ibu RiiHsiim butb). The «x(HM)iir« cuiiiot )>e proloitgvd lioyond 
t«n ur flh«ea minutut- 

OnKKMElt liu hi* work ontiUed l)t-r Hititcht'tff, 1BG7> hiw mmlo mi cxpf^rimontal 
study of tho cffoctx of hi<^h tompemtnrei (-10 C..). Animals who remain a long 
time i>x|KM«<l to A temperature a few de(jree» higher thitn their own i»ody-heat, «x- 
pemtice » rapid incruiiMc of body loinpi-Taturc; tbU Ixtiu^cauaed by th<^ iiiti^rrtiroiice 
of a cirnninanilik'iit high ln^miKirsturu with rtidiatioii of heal f rum tiie luttly. This 
radiation ui:'uml-m tb« mouieiit t)iat tlin tdniH^niiiiri; of tlte air fHiniiIit tliitt uf tlie Undy, 
lu itioh a t^m]>eniture 77 per oPtiL of the iiiurcnHi*!] heat (in mati) is rpuune*] in 
th« txtdy, uulcsv coriiUD reg-alatorft of body-heut sho>r iDcre&Acd fuucUon. This 
motltirAliun uf iucruflM'd heal is brought about by pi^rHpImLiun aiid iucrcHHid ovupn- 
jKliun tu thK heau.-<l extcrual air ; by (|Utckoucd rettpirutory iuoveui«nlM aitd the rti- 
ralliij); lo)w of wautr ; by heating of tlie blood aiid bltiodveMUPlx; by iucreatitxi mii'-tu- 
ritioa. The b"nly-h«ut in notably raiM-d by inorementA. i'itj>«-cijilly when Iho air 
tempcrAture wncMly (-qual to or exoeU the bociy-heat. The nipidity of evuporauon 
dimiuiMfauH with tbc (creatvr duuipuetm of the air. more particularly in a L-:diu. The 
jmituuU I'xhibic vnry much iiicrca-^ffd nstpimtory and cardiac action. If their Ixwly 
heat r^arh 44 C. there usually apjwar Htmng ocmvulBiouii. Aftar theHu tlm aniiinils 
an ancoamonK, their r^npi^itionM an; dxep and few, tlie pultu; hardly purc(-]>t(ljle, 
tiM niuctros membranes o^'unoied. They die with a rapidly iocreasing l>ody-heut 
(Dp to 45 C.) and ojtivul-iiori!!. if they receive neither foci nor drink In fr«ni two to 
/oar h'<un. The hejtit m in a paretic litate evt'u bf.ifurc death. After d«alli the right 
• of the heart ui found diHtcuded with blood, the Iuu^^'b and brain ehuw jkimivis 

CloiL 

'IValtiikr iifft. CfiitralbUitt. 1807. No. 40) has experimentally inveali^tGd the 
act inn nf nwliating hear upon the oinmal frame. He found that ratibitaand dogs wore 
kidol in inir ur two hi>uni by the din-ul heut of Ibu sun in un atm<iH|ih[Tin U'lujicra- 
ture of 31 -^11' C. During thi» (Miriod the heut nf the auimalv (nieaiturrd in the reo- 
tnmi ineiuiired 4-(' to 411 C. The animals thus exposed di«!d oyanowd. with ex* 
ti ■ I -i redpir.ition?' and heart-beat*, with tetanuB and dilatation of thu pnpd. 

'I ~ w>T>_- fi-mlt'red turbid, appeared dlBliuetJy striated in the lungiludinal uud 

lr.;„ . , di rL-ctioutt, t\a after boiling. 

'I'b* ;>!»( ni'TtfiH ch.tnge« observed by OBkltNlKR are »ub»tantially the ».T.me m 
have bren Ae«n in hnmnn heingii who had died of aua-Btruko. (Compare HeA/nuWi 
Jahrb., CXXU.,p. 2&2.) 

Tlie gimnrnl infliiriictt uf extrvinc-H of heat niiil coltl, hk tluiy ocvnr in cnir 
teuipet'atc' cUumtc-^ U not unfavorablo to th<* |>L-rforniauce of uil fuuo 
tioiia, bi'cau)$c tbo orj^uQUiiu quickly and easily nccoiunioJntifS itnolf to 
tli)> vHrinus nut uxutttttive cbangrti uf t^uiperaturo. Tbt.' Iur};<.' \<mm of hvnt 
in winter »iUA«!ii iiuirvtucd hfat pi-odtielion, and the Ihhha dejttM-dition uf 
hi«t ill sumiui^r cauHCit h diininutiou of body-hrnt; both no curri>s[M)iidiiig 
that Kit aJuioat najforin t4>mpfmture in tlie result. During nx|M)sui-e tu 
cold, tho low t«iu]>fratnre and the diiuiniHb(<d outanoouK cii't^ululioii ilimin- 
uh thi! radiation of body beat, and the p«r»piration, tbtis pl^'Vl;ntin^ the 
cnolini; by fvajioratinn. During cx|H)Hnr« to hnat the evupuiittuin uf the 
niUcb-inin-fiiMcd fiei-spii-utory seoretioa is a most important refiigui-atlng 
,llgmt. VVtlb increasing culd, the uiniibBr and depth uf llio nmpiralory 

uvnufUia. t)ie airbunic acid of the expired air, the volumu of insjiiivd 
ur, and the absolute qtiaulity of carbouic acid, probably also the aqtieouM 



«0 



TEatPEHATrRK. 



vapor^ as wrll an the absocption of oxygen^ are increased. Tlio nbr^oltita 
AUiotint of lixeit urinary iiigre<Jifuls ik AUgiiieuteil. l*b(?ee results render 
puHHililc the Wariug uf extreme ilcgrees of iir«t and coM, <'i*iM*oiiilIy w-lien 
llioae |>arts whicli are most exiioscd to lieat (tlte hcud), ami iIiomc wliieh 
snirt-r inoht from radiution in the cold (extremities, nose, t^ars), can l«^ pro- 
tected. Under Hiich elrcuuistauceft tbe limit^i of teiiifH-i'uttu'L- CHiii|>tiiible 
wiib Uiiiimn exJHteiiee are pretty Lirge, An Httno^iplterie t<.-tn|icraturi- of 
from + }'2° to .1^° ('. is that bi-.st euduivd by tin* hiuuun body. Itnmy, how- 
ever, s«p|Hjrc a heal of ^- iJO^ C. (wliieh i.-* felt iti hot comili-ies only in the 
sun), and a cold of —46" C. (whieb may l»e met with in Siberia). Inoider to 
Hupport life at these extreme temfwrntures it is neee«Kary that the body 
ahould have the lietietit of all niitiiral uid-s : in or<1rr to resiat cold one mtiet 
be warmly clad, keep up active movententa, and eut nutritions food ; in Lot 
weather one luuht di-ink u good deal iu order to obtain cooling by tbe evap< 
oration of the jterspi ration, anil keep ipiie.t. 

Atmoffpbcric t«nipe-riiture« which nqnaJ or nurpoM the nnmiAl h<>dy hcut (ST O.) 
become difHcnli; to bear, beraiuiie onr stin in acfUHtonicil to feci a cooler irarface on 
tlie outnidn ttmn on the mnidi*. llnbit hen* doe** a {rrvnt dt-jil : in niimmcr a tempera- 
ture of *ii C, iM deHyhtful. wliUo iu winter it woald appear unondumble. A few de- 
grt^t:* 4>r htiut ( 10 ' tu 13' C ) aru v«ry u^froeablc In winter, yet at such a temperatuift 
m •ummer we «])*mld cumplain ef Imiut; uold, eveo if we were warmly clod. 

Endurable temperatures may derange health in two waya : either by their 
nniforru long contiiniance, or by sudden variations. 

What may U» said of the resMlti* of long-eontinuerl, imiTorm, exti-eine tern- 
jieratures, in bn«ed upon the comparative st^tintioa of diwases, oi' merely of 
the deatltM, Mndied in years or in elimaira in which high or low temjiera- 
turea have prevailed. The general result, as coucerna death-rat*, is that 
the greatest mortality occura in tbe cnMest months, and the leabt mortality 
Iti iliH wuniieHt nioTitlm. March and April are the moutha iu whieh we 
Hnd tlie grruite^t number of tjcntlis in the cltmale.s whieh have been !>lud 
ied. A large proportion of these dentim are not euuaed by diseases which 
have developed iu theae months, and which c(mii«<<)u<'ntty were inlltteuet^d 
by temjMTatiin*, but by older airecfinn.s, whirh hav" gone cm to a fadd tt-r- 
mination under the in6uence of temperature, and more by ila vuriutious 
titan by it& absolute degree. 

It is interesting and even more important to att^'mpt to AAeertniu tbe 
nuoiber and nature of morbid st^t/'a which arise undnr varying oouilitiona 
of U'inperHture, The reaulta of such an ijupiiry are diiferent in vuiiona 
loealitii-.i, but nowhere do we obtain a maxiauim in wiuu'r. Tlic majority 
of tlinea^ies occur either in the spring, or in the Hurumer, or are r>i)iinlly ili- 
vidi^d Ijetwfeneacii. As r<>gardH thf nature of diseaai^, we can aay with acrii- 
nu'y tliuL i\\t: respinilory organs suHrr more in winter and ^pnng than iu 
aumnier, and in tropical countries the digestive organa and the glamU (the 
liver) are more commonly aSectetl. We may also Bay that brain nifectiona 
iu genera), and t«-tainiH, are more fn*(pieut iu the Kummer ; auJden deathA 
Hiid apojdexy are more often aeini in winter and spring than in auumier anil 
autumn. Aa regards ejiidemies, eliolera and dysentery are more eoutroou 
in Kummer; meark-'t fever, meaalea, Hmall-pox most frequent in winter ail (1 
spring; typhifjd fever ap[)earK moHt often in summer, fall, and wint**r, aol- 
dom iu the Kpi-iug ; iu our ouiiutriea intermittent fever uppeant oitly in 
bpring and nntunm. Htill, in epidemic and eudeinie diseases the tempcrar 
ture of the air ia not the only cauaul iiifluencoj as ia beat seen iu tbe caae of 
iho plague. 



"CATCnraO COLD." 



61 



The or)(Anuim siifivrs moi'e often ao'l more severely hy suJden changefl of 
tempeniUin.' lIdiii by a long coiitiDuatiou of itii extreme degree of limt ur 
cu1<), uDi) (^veii tiy thu roiiii'Oftt of t(Miiporat(ii*(<« 'whicli by (liHiiiueivtHt aro 
pt>rf<:'Ci'ly Uairable atul have heeu ofu>a Ixmie without iivil reaiilu Tbia 
plionomiMioii IS calleii " cAkibing ci»Kl," or re frige mtion. This opniites 
to tbe Host iimrkk*!! detrtiiieut of beultb, if the (lilf>!rt*iitly Rcutotl air is iu 
ntjiiJ mntiun (drHu^bt), uiid if it sLriki> a^HiiiHt u purtiou of skin wbich was 
prHviously eoveretl, or wliich is octiiully |H:r>iiit'ing. 

With this uiidLM-standiu{», " catyhing cold" niny bo designated as an iPtio- 
logicii fiict. t.)f tbetnilh of thix every one, even the most inci-Kdulons, may 
become coiivinoitd. But this letiitloi^y is ofttm miaapplied by lay iifojitt-, and 
by some |ihy))iciHits referred to though tle-ualy, and tbe pheiiocnuua rt-iruiin 
»liruuded in inuob durknetts. 

Many healthy and Hii-k jiersniiH doubtless expoKe thenuH^lvus day ufler 
day to chimgea of leiii|H'rature, and yet experience no evil reitultH, If the 
teiiipei-.tlurtf of a room bo +iri^aiid tliut of the oiitHidc air — li^°, we ob- 
tain a difiVrence of 30^, and yet ft.-%vfr people aitcU cold in the depth of 
wintorr than in spring and eumnier, when the ditTereuce is of a few dt-gi-ees. 
In cold weather wu take partiL-uliir piunu to protect oum-rlvf^, and pi-opto 
of a noi-theru etiiuate hvc much mure careful in thin ttn^poct tliaii th'Mo 
uf Auutbr^ru couulries, or even thnn the iidiabitant^ of C4>utrul (>erriiaiiy. 
If wi- fX|Kise ouraelves daily to such changes of tempenitun*, we eau- 
not (Iftt'ruiiiie with accuracy whether a dist'a.se which uppi'ar^ in uk lh con- 
nected wiih u refrig^rrttion. When the tliMt-asi' lia8 ma>le iU a]tpettiaiu-e it 

euiiicR vi*ry fitAV for evi-ry nne to reniemlter ha\iTig *'c.iughl eld." Tlieiio 
Icori'iiit'-'iutioiia are not, howcvt.T. eullicii-iil to di-ny the jMjwiibility of the 
e({m;nee. T»'u phen<»iiienM U'stify Iv thts association of a disease and i-efrig 

fttion : either the perwm refrigerated feels diaagi-twahly at the time of 
Rcatcbing cold, Aoon litvoniett chilly ; or, Kecondly, there soon foMow gi>iiei-al 
morbid iiomuiiiuiia, and the beginning of decided ftymptoms of diseane. This 
vOcciira 80 often that we artt authorized to aiisuiue a relAtioD between tjie 

frigi'-ratioii an<l the liitteaite. 

The disr'usfr!! which certainly aritie in this way, arc paKicnIarly the so- 
called rheuTuatieatfections; that is to say, thoae morbid atates of the joints 
and mniscles attonded by wandering [tainn, us well m catarrh of the mU' 
ctiUH mr-mbraneB — of the tmsii, larynx, bronchi, of the intesdiies, fiHt-ticu- 
arly of the targe inte«tinefl. More doubtful is the conni^ctiou between i-e- 

geratt-in and the more severe endemic and epidemic dtaviL-ieK, roncerning 
which wt- kiKiw lliat thry eerlainly dHvi-lnp without i-efiigcmtion. Still 
it cannot be d-Miied that in ehoIera-HeasoiiH refi-igei-atiun nuiy hi* the 
proxitiiatii cuiiM' <ifnii nttnck of choh-ra; and that afler rliilling, an int^^r- 
niittetit fever will kIiow itself after the individiiul has long been removed 
from the irinnencii of tbe raiiutm. 

Annth'T point is the relation of the chilled surface to the organs lying 
near. K<dVigeratiotj <»f tin- neck causies, it is well known, ciitarrh of the 
Urvnx, that of the chent, tironchitiR ; a ci»Id in the head xa easily pi-odnced 
by pa-ssing from ii warm room into the coUl air (and vic^ ofirttn) ; disorders 
of lueuittnuition are ]>rodneed by ehilling of the feet; diarrhtua very ofleu 
is net up by refrigt'nitinn nf the skin of the abdocnen. But then we abu) 
meet with another re-iult, viz., that if an individual ha.H a ao-called tender 
p«rl (fttMfM minoiin reiijif^nflfr), that juirt In-eonies diseasetl, no mutter whei-e 
the ohilling ntay have ncterl. 

W(- have no further poiiilive knowlwlge of the doctrinra of refrigeration 
(catehing cold). The notions which have been Advanced ooticeming the 



62 



1N0 OP PKBSPntATION. 



coinioction liotwci^n n-friijoi-atiou and tlip diseases which arise fi-om it, 
are 8(>(iKitilile into ilirei; tlhttiriea. hi tli»' tirr.1 place, it U cLiimeU titat tbr 
cutaneous spcrction is nrrested by tlie cliilling, lIihI. aiiiMwiuHnlly injurious 
BubntaiiccK ni't* r(*tuiuediu tlic bliMtd, and tliHl the local dinfmm-H mIucIi lolluw 
li|>uu till- L'hilliti;; di>)»'ud upon (hr di'*}(OMit of tlirse tniliMtua-eK. All tlin**! 
eltiiui-ntK u]inD winch tlie tlifurv ivsIh tttv pure fictions. (I.) It ihhy no 
mefinit certAiu that the eichalutiun of liquid frunt tbe hkin fHU \w iiiat«- 
liully demu^iHl by chilling : (2.) no one bwi evei- Been the puisoDOua 
malui'iul which is said to bn re'tnined in the blood : aad (!f.) it bus nevvr 
bo'u discovereil iu the diseased {Mirt. 

Abovp ull, tin! phenuraena whioU occur after a complete arreat of tba 
pfrapimtiou by vnniishiiig or lH(?i|UHriog of the skin nf aniioab dcpt'ivtHi of 
fcHtUers or hiiir in nowise i-raeniblc thost* which eimm* aft<T tyilrhiug cold. 
A Accoiii) view seek)) for an explaiiaiion of the morbid ntale bj suppiuniig a 
transient Kuppifttaiou of the cutaneous secivtinn anil itn reactioti ujiou tU- 
8ue nif:tAmor]ihosi8, causing iu a measure a mechanical reflux of tlie animal 
]it|iiid.s. A thiiTl ilmory n-fent loan affi-ctioli of the uiTVes nf tin- (-liillfU 
skin, an<I to their conm-ction with tht; nerves of other orgauB. The activity 
of the Hkin fxhibitn it-si^lf in the excretiun of sebaceous Uiatt«r, aial of water 
viritli coustitiu-nts held in solutir.mjWhich latter appears iu the forms of iiwi>iit 
or of vapor aa insensible perspiration. Bec^ixmeitf its pundy locjil ndaiiorui, 
and t>f it« incapacity fur evH|M>riitiou, the sebacfrouh mailer may Ik.* left out of 
consideration. The aqueous excretion varies extremely, uccurding to the 
degive of external tuniperature and the amount of corporeal activity. A 
draught of air, however, whicli striken upon a inoiKi surfuce, tnnst pivtdnee 
a much greater re frigu ration of the pai-t than if it pa«s«^'d over n cIit kui*- 
face, and in the first case itii influeiiL-c u|k>u the tibsues of tlio skiu, *nd 
upon the nerves in particular, nuwl be more inteUMx and di-eper than in (he 
8*^i.md ea«o. Fnrtlieriui're, llie energy of the netion ujion the |>eri|.>hvni1 
exjiansion of a in;rve, iir upon the nerve ti-niik ilwlf, is intluenwd by JUili- 
Tiduat i"cciiliai"itiea. We may well conceive that by a certain Hegi-ee of 
refngerntion other nerve tractji, particularly the sen.Mtivn and vaitwmotor, 
may be put iuto a state of irritaltun through their efrnnccuon with Iho 
chilU^d uervea. Iti IIuk maimer the iullueneenf ehilUng umy be nion? ea*(ily 
expliined than by the assumption of uu urrotled exhalation of excrcttion 
jjruducta. 



The dnngcrous tfTecte of arTDktiid peii|)[i!atloD were alreiwly knowu to SATrroRio 

tl(iU|. There nui flXju'rimi^utAl mar^Trh'ii upon this, sdhjtft l.y r<>i-ll(-Ari.T 
[Covt}}tfj> rcMtun^ IH:IK| ; DrcKos ( /"VwAt*** TVor, IWl) ; Ili:rijiii.iiKl, nnd Il«Kfr:ilKT 
{.-ImA. wm., 1841. XII., p. .M7); Gl.COK(.4M. i. I'hvK. «. i\>th., \>*\\\; MM«KSDIIf. 
[W'U. M^4„ IS1«, 1>P0.}; Gmit.ACir ( VMtf<tr'* Arfhiv, IHM. p. 4«;/ ; VAl.e«m 
M/vA*V / )^nf%. Hfiik,. IHTy**. p. 4;j;n: HtRSAIty \.ir^">,»tHr (f* jm'iirirtr* jtAj/a. del 
Uqm'IfM ^t r(»ry/«.(M/«/', I8.*i!), II., p. 177) ; and loiuly bv EPEKnuizas {/.^tUfhr. fdr 
rat. Mr,L. V. XVn.. pS,"!). 

The evpcrimcDtM inidtfriaken by KdonhaiKftn n[Kia Tnriniui nniniBU1w*fore or aft«r 
aliearing ot pluokinB-. by mt^ans of ilifT>7rcDt sulmtaucefl imnciLitrc nf g\\m amiife, liD' 
■eed oil, Uiis4?e'l-oil vami^h). showed tlint aftt^r KincnriuK of the ciiLiMi Rarfa«-e of Uuj 
tHMly, thpuniuuil. rabliitH for inst-iniCH, died in from .'> to '»:( hours, nfl fir hnvirc/ • xMlntM 
ihft fulhiwiinr ".VHiptoHis : gTBut trembling', extrenic re»tlptwiiP!tj;an)l djfi)" iier 

with piiralytio pyinptoro*. tonic and cluido sptu>mfi followed by an np it«, 

with rapid diminutiou of body-beat, of the rc>[iirniur^' and uardiuc ui'jVLU.t_i.tA. Tk* 
urtno was iu mruit ciiava st-'crcttd in uausunlly laryv tpiruitity, wu8 of a h<trh f<i>cai6f' 
gravity, mid .Homttimi-s, afl'-r a few I ouiw, containrd iilbumen. Examination /«■' 
nfift^tn sbnwf'd bv|t«!m;niiii of th»; inUKcli'i. tbr Inngn, liver, u»d Bpl "'n. iiiofp or li*a« 
marked BtfmuH efFutuon in thn (•oroufi pouches and in ibc (.nbcutanenue conacctt\o 
tiBBtu, coobymoacsof the gfaairic maooua inembraoc. NVherevertlieooaitugcKtaaUrd 



MOiaiTUtK OF THE A!B. 



63 



the pkln w- f -vi'l lUfo Kypercmic. Upon it* iutertml durfnco (.h'»re appeared 
a «Ui>ii^ i) ' of bloiKlvpJDfvU, which nt tbf> limiln of t>i«! vnminli coal xhovroit 

qnitoit'ltf^' ■ ttioii to tha covrreil purls. Nnmproiw lymph-onrpmrlcs were 

fuutul ill the iterouit L-tfiiaion of tb« etmiirftirn tinine, iuhI (niso in the jH-ritoiieum of 
inufft of Um« nuiiaals) cr^itt.als of triple pho<phat<! ; these last bciDg found uvoa wlieii 
tlic BxuniiutUon wofi moiln Emmeiluktoljr iifu:r death. 

C. Thk MnisTi'RE or THE Aiii. TIic atmosphere w tievr>r Kl}KoInti:ly 
dry. Wf call it ilry, however, wljfn it does not contain ntt ninch inoitttuiii 
BA it iniglit fiMitiiiri nt thi> Hxirtling tcni|>fratun> ; 8Htiir»t(>(] when it <ii>f>R 
<XMi!jiiii t*s intich ; nml ihunp when n-hitively to its hcut it !ii>I(In timoh 
Water. At a high'T tcnipfnitiire tlie air can takp up mnrli mom wati-r in 
a j(iri>n volume than nt a lower. A warm nir (loiw not, hoMcvcr, weem 
djunp ta 1IA liecuuKf much of the water it cuntHin>i in in the uliitv of vnjior ; 
A CMolcr air iMintainiMg the Mitnc amonnt of moiHtnre luola (hunp to iis 
(ffcauue \xa water is i-aKily eonth>uM-<l, tiie more so when the full of U'mpcra- 
tun? in ami Jen. The dew, tlie tlainpiieiM- of our clothiug are indicw not so 
much of thi- ulwolul*; inoiaturt' of the air iw of it« coolinfc. 

Tlie air UdryfMt iu tho early afoirnnon, nnt) moiMtcst about stinriso. 

Other things being espial, thf> body, i.^., the skin and tho hingM, oxhal« 
mon> water when (!m.' air in dry, less wht'U it U dmiip. In tho lattt-r cnse 
the urinary ftHCix'tion i« more nbiin(limt, in the fonner scanty. A iniU] and 
tuoint air witbtlniw<> much hent from the iKidvi whennut a wnrm and dry ail' 
iiicr«'aw*»s the l)ody-heat ; c<»id and dry air luoreases th»? cx|M.-iiditure of boat 
from tho bo«ly, aivd wo feel much eoliJer under these circumstances than in 
dnmp air nf a strnihir trmpenvtiire. Cohl dry air, by irmnvini; much fluid 
ftiiUi (he blood, raurtoa con[^tfttiuii nf the biiii,'>i. NVaim niul d imp air most 
im|K-de^ the radiation of heat from (lie l>ody thruu^li the skin and lunga, 
cauM^s eiLh:iu.*ilion of the muRoutur and nervous HV^teuiH, ri'slniina the res- 
jaintion, diniiniahea the aiipetite, imjiaim digeittiou, aud inereaMea the |ier> 
epiration. 

Wth r<'ft!peuo« to pplilemlos. ao rvanXU Iinve l«>en oliUined rroiii thp estimation oE 
tbu oinfmut tif uioiiiLure in air. Murtality. aoconlin); to CAitl'tK. acema to \ta Icaa in 
fiftuip monIhA, aiid (,'reatAr in Ihf' dry <cold or hot) ; but tfaia f* only probably dapen> 
dent il|tr>lt the FXtr*>tiif dngrftO nf hrnt Aud culd. 

I'KTTKSlii»v"KK lin Zritj^hf. J'. Iti-t"iit>. I., p. 181) discufws the tiuuUt* nj'rntiuli of 
Wrt r<ffi If ncTi'ouit* frum out of doom with wet feet into a wuriii room with dry 

air, a ■ — 1 'iti'Mi cpuinimici^i*. If wu have only an nuuet kikI a half of 

it " ■!] ()iir feet, ihw water il cimUunfi will nued ko mni-h h»jit for 

'&*>■■. ■ it>i U ft Itnlf poiiud -if H-atcr might ho ratwHi from 0' to thf 

1" ;. or iiuirti than a hnlf iiound of ice nteltvd. 

■ it up ft vratur in»leoule«. It is not included in the moifitare. It acts 
I .1 » ctHiHnK a^unt, and doM not dJininiah the oajMoity of tbo air fur the 

I :' <'f moi-itura. 

D. CoHTo^iTioN OP TnK AIR. Thfi air which nirroimds us. and wbioh 

w ' Middorii entiiely piiie, but i« ustudly adulterat<'d in a greater 

I' The bubbtancea mixed with it are nKxlH'MicnIIy or ehemi' 

cnlly iitjui'iouh. 

TfacH facta arc turned lo practical account in the treatment by inhalation. 

(•I.) MKr-iiANir.*!. iMriiRiTiKs. rulvRrized suhHtnnpes held in aufipeiuiion 
in l|i« air whlom act tiiK)n the skin, luit do fo more oft«n upon tli'* con- 
jntjcCivm, where they protluce irritntiuu and inHamniatlon. Their effect 
uiKHi thii air-paaan^ea is, however, most im]x>rtanL ; an effect fnH;jpent!y 
tib«enrfd. Theae i»u-ticlt» are iu |iBi't caught by tbo mucus of tlie tubes. 



b 



04 



UKCUA2<ICAL miTRITIES. 



then C'xiH'lIed Ijy iiifyiiis nf the vibi-fttile ciliiu-v movptnoiit. aiid li\ liitnkfi 
and eoiighiii^. A pari, liowevtr, rtacli tLe air-vcRicU-s, |ifri''iiHlc iheir 
ppitlitilium and walln, nn<l either remain imbedded in tho iiit«rf<titiHl tiii- 
Btie, or nre CHrrii'rl )>y tlin lvni])1iHtiL's to tliH intitrlobidar and siiliiilciinil ttHstiB 
(even in false nienibrancs occidenUlly prosfiit) and iuta tbo brouchul 
glandft. 

Thu inlialnd MiliKtHnrea arp ft»r the ini>Kt part du>*lK, esjiecinllv atrcwt- 
duht, pliiiiiney imd l»inji aont ; more seldom snlw)ljinc*'« wliidi ain set free 
duriiiji; llirindiiNlriid devi*l()i>inciit of tlu-ir urtivily (coal-diiKt ]>y workt^rs in 
cimbi, by mon eniplnyi'd in iron-works, by chaiToal-makcrs; Rand-ilnitt 
and imrticlea of llint by stone- cutters nnd griudere ; fibres of flax, coltoD^ 
etc., by wtiivern ; nu'al by inilb^rH and bakcn* ; iron, and it* oxide or pro- 
toxide by BUud-grindorR. gold bent*' is, looking-glftRa poli)ibM*a. and otbrn; 
tobacco powder by tobueconiata ; color parliciui bj paiuters ; ullcate of alu- 
mina by ultniuiarine-iimkera, etc.). ' 

Tlie proufH tliat th«s« KiibHUni*os are inhaled are given in part by lan-n- 
goscopic observation, in part by tbi^ oximiinntion of the sputa, bur i-hietly 
by a slndy of tlm utfeotod iiigan itsidf ; ibi* identity of aiibsritneiifi fonnd 
iu Ibu urgnn, with tbo^e known to )^j s\iH{x.>uded iu tbo atnio^pben^ b<>ing 
e«tubIi»btH.l by niieroscopical and chemical metbuds. Tina succwda be^t in 
tbo c»s«' of certuiii eburact^^rizod snlwitaneta (I'barcoal, iron, silitnirfis, nr:C.), 
while ill ibft caflc of sneb aa j-est-aiblo tb** nulanine grains derived from 
blooti pigment, only an approach to certainty can be ifacbftd. An<I, laRtly, 
the traiiHMortati'^ii of pai'ticlna ran Ih> expeiinifntjilly deinDnHtnite*] ; for 
after it hn<l t>fen known that in ;iniiiiala subj^ett^d to thu Miiiic eunditions 
M man, a lung atTection jnst likf- tbtr hiiinan coal-lung waa di^veloped, 
experiaicntB upon young, or confined nnimals gave the wtmo result. 

Tbo consequcncea of the inbabitiona of dii«t-liko Hobstiincns ih*pt*nd upon 
ilieir amount, their kind (Klmii> dust-part ich's, auch aa tbuat^ of granite, 
steel, ojmrat« ninst injuriously), and tht condition of the rcHpinitory pas- 
asgcs. 'riioy oonaist of, in the fii-st place, irritation of tbost) poa^ges wiUi 
conaecntive Imwking and coughing, later in bypeneuiia and eatarrli of the 
bronchi. The suWtaneea imlxMhlvd in the lung tifsxue prO[>er. in siuall quan- 
tity, aK in present conditidnN iiiny bu seen in btirnan beings of all Hg>^ (the 
so-called lung pigment^ anthraknsin of tJie lungs), do no pai-ticiibir harm. 
Laiger muintitiej! cause diminution of tbo ri^hpirutory surfure, diminution 
of tliu cbi>*ticity t>( the lungs ; lat«ir we have capiilai-y bronchitis, catm ibal or 
int4>retilial pneiunonia (fibrous nr ]iiiruteht) with their cnniplicHtions, p{g< 
mental iudumlion in the 8bn)>e of nmalb vcr}' hard, sbot-Ukc no<lnleSy 
which art.- sonietiinca colored hhtek tltiougbout, iu part white in t)te centre — 
broiirbiertiiMitt, (he NO-ciiHed cJircuiio tnb«renloaia : fmeHtitwiokoniona att^ 
UirarotirUy si'/fi-oiiiyij cJui/iet>tirtif etc. 



I 
I 
I 
I 



BnuiK, I)r Spntlnnr hippomtticn ifjK'n'ffrnim Sfrftrrf/n>iii"*/i, etc, HhIIp, 1721. — 
RAM.t/ziM, Df morhi» nrt'finim. 1T17.— Pfah(m>n. /*/h7 7'mn*,. Iftl3, II., p. 150. — 
LAE^Nl:c. Tr>ntf tk F,t>ucult. mrdftU, IMIO. - E. H. Wkiikb, IlAifhr. Amif,, 1^2, 
IV.. p. 211) — *;keoo«t. EiUnb. M<*i. nnd Sury. Jounwl, ISJI, XXXVL. p WO. — 
W. Thomson. Mrfl-rhir. Trn$,»., is;t7. XX . i>. 'I'M), \^^% XXL. p. Ml.— GRAirAJI, 
Efiitih. M>4 nutl S>tr{f. Jannutt, \HU. XLII.. p. :tM. — Bihm'kuann, JMr m^rtlL. 
KraitH. iltn fi/mfiarz'M. iHTd.— Thai liK, lifutM-hf KUiiik; I8IHI. No. W n. 50 — /frr- 
Un. kUn. Wofh'hf^Sr.. IStMi. .No. .3. — Vii.i.aKkt. Van i^irnt tf'iiithntc., IfHS. — CnocQ, 
PrtJiKutfiL iMi}f. IWia. Xo. «7 ff— I.kwi.n, Ikiir. i. In/ml.- 'J7irT<ijx, !Hi>:i — Kiss- 
UAUL. Ari-L f.kUiK }frjl., miki. II,, p. i;y.— ZitNKKn. Mi'rf.. p. llfi— lEosr.STnAl-, 
Wuiirr Mnl 'Jnhrh.. IHIW(. XI.. p 07.— KNAUiflf. VVrrAm/V At^Mlr, ISI17. XXXIX.. p. 
448.— Blavjakkky. /Am/.. 1H6». XLVIII.. p. 836— MHREt;i., Arehir /. kiiiK Mat., 
Itttl. VUL. p. 20(1, IX. p. (W.— HiKT, Vu St'inbinhatationsirattk , mil. 



JKm 



ClfKMICAL lAIPlTRITIEi!. 



65 



Kjcitt tiM Skriuitir- fortuft contnincj iu tliu air, tiW/* in/rn. 
4!XbVVlUpa' r.thktii(f ncilnm of IIil' hnir {grcRU, rrxl. Iiltte) are prodnoed by the d«- 
yeilbflf IWioos pl^neuts ^.copper, inili^a, etc.), and not bj* tnte obemical oombina- 
tiooa. 

0. Chehh-M. iMi'i'ttiTiES. — The pjiseous conslitiietitu of tlie air in opim and 
in onliimrv iucK»se<l sjiaccs da not undergo as iiuicli cliange ftii one nii^ht 
expect thev woulcL The jiruportiun of oxvj^nn nud nitrogen olwars i*cinain» 
til© ifuuje (21 volnrDRS uf oxyj?en, 7*J volumes of nitrogen) even in i>ver- 
crovTtlf*! Piimix; there appear, however, in ancli places a small imrriiaKe rd 
curboiiic acid^ i:iuuie amiiitjijiu, the fluid a4.-id» of the sweat, as well as occa- 
siurtally the piiti'id orgHnic uitbtjlMjiufS of evH|>oru(iftii. Tliu best known uf 
these changes cunni«t« in the jmiporMon of carbonic acid, of which noruiul 
air cont«iiiH from '^ to H parts in iri,lii>0. If the amoniit aurpaMWH I i>er 
oenl., the atiiiusplK'ro l>t.tcoin>rs uulieallby ; if theru be mure than ^ per cent. 
it will df» harm if long hreiithed. 

Although it i» certninly more healthy to hreathe pure air, yet it cannot 
be said tlmt definite difteitses are prodnccd by air made impure by huiuan 
exbaJations. If factory hands, children who o^'erlill school-houHes, look 
pale, are aniciuic and scrofulouH, it must also be borne in mind that they 
cannot proqunt many things essential to good health, such as nuiritioua 
f(K>d, etc. 

The eontflminatiou of the air by large amounts of otrbouic ncid, cai'bnutc 
oxide, hydnjgt-ii, luninonia, rarhim'ttfil bydrogi'ii, arseniurL^tted hydrogen, 
etlier, ehlurofonii, tiouie i>f which act Lii a negntivo wav (aHphyxiu by car- 
bonic arid, nitiMgtTi, hydrogen), oth<Ts iloint; positive injur)- fcurlxmic ox- 
ide, carbiireiu.'d liydifjgeii, siiljihnn_'t1*td hydrogen, arM-DJu retted hydrogen), 
will In? U'caUhI of under ihe heail of p<.)itwus. 

Oases and mixtures of giwes, in their relation to reepiratioa, are diviftihle into four 
fIToupi iViERUKirr. Kakkb, FIeum.ui>'>: 

1. ATMinii'iiKKic Alu. — Thio alone eon be breathed fndcfinitdy lonif. In anocm- 
fiii' ' I - it* cumpovitiou in nlwa.v» fuuuil uuifmtn, ujid rvcn m cliMcil nKims in 
» :m: many purxonn t!rjiij{rc+rat*sl, tht i'O, cuinioc enoilj' MtrpriKS 1%, Pkt- 

Tt-:> ' ■■ fonnd 1 pu-t in 1,0()0 parts of lur in n mtting-ronm withont vcDtilation, 

in a iHCttirc-room from 1 to 11, in a scli'MiI-rooin 7 icithcrs rh miicb aa \i.4), in a com- 
mon ro"m at an itn lufter {{ueKtH had been in it wreral houn) 4 tod purbi. Ln.Bl.AN(' 
ioniid in the i^ulerre of a theater I't itnrtA p. ui. (per mille), in tbo hixbL-Ht part uf the 
tb«»f.re i'-M part4 p. m. uf CO, aft«r tlio porformauce. As M>t>u as olr cuutatiiK more 
tlL, ; 1. m. of CU, it b«icouicsoff<Muuve tons, bjrcaaonuf ibe adniixtansof 

o ' : -dui-U of i'xUaliitiDii. wlioM exact natiiru i^ nnknown. 

;_ ^ <,...,•. il'irrff'jii/n-Ab /. i/jf'. (imuntUieUitjffii'fjf, IHiO, II., p. I7)ha»pVBn 

u infomtnli'm iMnccniiii^ tint Jn(.'r«.-iM<! uf ciirbimic acid in BcliDol-rounu dannjf the 
bourn of iuHiruction. In a scb-jolroom be found : 

At beginning of Haiir. At rail •■( H^^ir. 

From 8lo A.M IK -W p. m. CO.. 

OtolOA.M 47 ltd " 

lOU. tl .\.a... 03 81 

'.Jto ar« 55 7B " 

3to 4I-M 05 94 

Small rrlntire increniw of oxygen occurs nnder a high barontcter in oold weather ; 
a -llnntiiitinn is obfterrnble in lung, lint oummerK, in tropical alimutes, in mid-ocean, 
»ti ■\-\\ ntfiniitnins. Grwntor i»cn*njt« <if oxTRfn in mndo ueo of for theilipea- 

ti' . ■^ in tl»t> *fl-called pnenmntir oabinptH {f^oc p. Mi. 

'.', (. tt-L-* ivimii, wnii.K SOT n>»iT!VKi,y iN.n moirs, no uahm dy kxcludiso 
OxrnhV. — NitrogfJi and b.vdroyen, and, to a dcffroo, corlioiiie fii-id. Asphyxia in^mrn 
becnnM) T.he i"-. •■ i r.ir doea not coiitAin nxyyt^n cnoajih to supply I'j tbu blixMl-uir- 
pOKteft tbr* 1 i]uired forrhn mntiitriiJims! of tho normal ooiiiput<ition of the 

blood. In UI \vn compe«fed of tliixMi ifattus, the ncntfe of want of breath is 

felt as auon ut Uluud iMuea from the lungs in a renous state ; mommaln aro apparently 



66 



ciTKuicAL DtprRirree. 



d^ad in 9 to 8 minnttv later. In pnre tutrDgi>n gut, carbonic ncld ifl separated from 
the bIu<Mi. find iiitrog«ti toiken up, but •ml.r in kiusU quuititiea. Similar pIinnomeuM 
hTo obiMirved during- tlm iubulaliuu <>I hjdroffca, aud. to aoiiie extent, darmg LfaAt of 
CO,. 

S. MrvTmB OF Oarhs of tiik SKOisn finorp with Oitokn.— If tlip nitrogen 
of the air be replno^d Lit liydrnfrun. the animal continues to breathe >vlt.hiint diffi- 
culty ; an inereawi in ihv obnorption of oxygon, as well u in the eihaJntioD of lair- 
Ixmtc ftcid luid iiiin>(^ti. tain-it |>lim>, the hydmKPn retiMUDiag almost uualtercd. In 
m curtain HCUhR, protoxide of nitrogen in u aubfititutv for oxy^t-u. It may be inhiJed 
in largo <ji)&ntitief>, cituning «:fn)tation AymptoniH, a condition like dninkenncna, etc 
Under thffee oirciinittancf-H mucti of it is absorbed, and from it« dcoompofiitioa car- 
bonic arid Mild nitrogen are griveii off. 

4. GAfctf WHICH AiiK iHi-fiTrvF.i.T iNJcnioDs. — They prodnc* dccompositioDB 
when takuo iuto the IiKmkI ; nmny, mioh iw chluriut. nininonia. tho mtriU-n, hIko pro- 
duct) Htrong^ irritation of the r«.-«pimtory orgnnii, ahuuditut tieuretiuu from tlie bronchi, 
voogh, and Inrj-ngiMnnii. Among tho nioHt pot.ionoufl goMiit are carbonic oxide, csorba- 
retted hydrojton, nuJphnrrtted hydropc>n, arKt-ninrctt*:*! hj*drojfeii. Carbonic oxide, 
to which infjn^dicnt 1 10, Hi, and more per c<_'nt ) iihiminatiny gaa owe» itc i>oijKmoDi 
proi»enie8. imite-H with tJie cotorini; matt^T of the blood to form a carbonate of hem- 
ojilobiu. aud by it osy^r'H in wholly driven out of the bloiid. BIood-corpuw:Ur!t i.'liaijr«d 
with airbouic uxide cunuot tukt; up any niurf oxygen \ the liloml in of a diiik i-huriy- 
red uolor. The poinomma giisefi in privy-vaults are carlKinio add and Mil|>hnretlcd 
hydrngwi. The wirbonic add acts fn part negatively, in port poritiTpIy. by an action 
npon the central nervous Hyoteni ; it suddenly kills (ranKlion-cello. The tsulphnretted 
hydrogen acts by losing ttit hydroj^a, which futnia water lq the blood, thus Kttiui^ 
Bulphur free; the bluod i» at first yt-llowi.-.h gruen, later Uiick. 

OzoNK dcJicr^CR a sprcial meniiim. It is, an ts wi:U kiujwn. n miMlificntion of osygcn, 
wliioh hay irreator oxi'iizin^; jiower, and whicli in set fn:c by evurj- diMohargit of elt«- 
triuity, anil nixo during nnddt-n proci.'E«es of oxidation, an, tor i>xnmple, whnn phcM- 
phom!i is Bboken with air e\<<n in the dark. Oxone playii an cxctK^lingly unportant 
port in the animal otf.'ani^ni in its relationii to respiration. 

It cannot be doubted that tho hlotHl-corpUHeles i;urry the oxygen of the atmciephne 
into its ohomicnl uotivity. A proof of thix ii* afforded by the beha%'ioT of hydrooy- 
onic anid. When it ih introduced into the lilond in small amount, it laiuiwfl drath by 
asphyxia, by briiigiut; about aco.!i6ailon of oxidation procewwt and inatamorphnsi« of 
tiMne; added in similar proportJon to blood -corpusole-ii it destroyn their .'npn«.-ity 
(which they have in the igime way an platinum) of deoompo«inf[ the peruxidi' of hj- 
droifeu. Hydrouyuuie acid alw denlmyn the p<nvvr of blowbcorjmpcleti to ehaiite Ifae 
eondilion of oxyj^eu. and thu« demon etratCH tho very iutimuto relatioun exintiog' be- 
tween the curpnitclpit and this element. Hence followa the great importance ot oiooa 
in thi* vilnl iToniWfeR, 

Physician* are aJlogethcr too ranch inclined to connect the otone of tho air with 
dtseoscN. Inaamuch a» or.ono irritates the nmcon* mcmbrnucu, for o lonjif time oU 
opideiiiie dlBcaaos, jKirticnlarly iuHuenzn, were thought to be dependent upon an in- 
oreaae in the amount of oxuno. In the Inst two yearM the oiMin« eontainni fn the air 
luu bean freiinently and thoroughly iuvertigated. Thfiw iuvesiigatiana have )d>o»-n 
no Bi>e<;ia! ruUtiiia of oxnne tn inflammatory iliiteaReii, wbioh it. B)i(*uld havu iucn*aiM!d, 
and none to mtajtmntic uSections (typlioid fever, cholera) tn which it wa« thought it 
would be diniitii^hed. 

Ozone may inlhu'uoe henhli by de,atroying fetid (foaoi which develop from dccom- 
pooinK ouimalH and vegt^fibles. The Uierapeuticol uoc uf ozoue ogoiuflt ovule utd 
clironic di^eoMCH, particularly the so-called, septic dineoMW, boa been of late ocaitt 
recommended. 



I 



e, THE ELKCTBiriTV OF TBE ATMnSPHHHE, 

TltHt li^litiiiitg Hoinetinu;8 sitildcnly kilU men uid oiumalfi, sometimra 
lanms iiml stuns them, is well known. Woim'Is iir*» not always futmd in 
the.si-' <;«Hf-s. [t, is also known tliiit the muscles couti-act when an electrical 
current in upplie<l to tlu'ui, or broken. It 'ma very dilTercnt Miiug, however, 
with tho oltrctricity nf tlie iibtntM^phi^re aiiil itn Jrgrpe of tension. Its iiifla- 
eaco upon health la very questionable, or nt leu-st little nudei-Btooil. 

For « study of the electricity of the skin, se« Klbuu, JjmiUcfi^ A7mij^ 
1872, No 41,48. 




wrm A2n> uonr. 

t MflVKMENTs OF TlfK AIR. 

A cnliD id dangei'oiis, because ilaniig its coniinunnce the prod'icta of de- 
ounipniuttnu of aiiiiiiftia Rml plants, iw wi»ll aa inarHhy exhaInlioul^, an; not 
tUs^H.M^ii'cl. The wttrmer ihe air tho tiuire tliuijjenms is the calm. 

Vie vnll it a mlm when, in t\\e opoD mr, Che atin(M|)heric curreni dous not exooed 
on»:-balf tnulrv i>er afccyud (PkTTESKOI'BH). 

A modiTtttR wiml in wliolrsomo, since it ptirifira th<» air bv pminotiiig 
Tusiuii of its constituents. It occHHionally becmin.'A iniufintin hy trans- 

rtin^ tluftt anil niias'iiata. Strong winds ai"e daiigewn* fur those liaving 

pwlmnnarv lUswast*. hc'^iune limy rfudoi- ntiipiiuti'in murn <li(fieul(. 

TIh* tlin*etiitn of wiikU is of int<>r«'st, bt'caiise ujinn That dfjwnil tho hviQt 
anJ nioialiire uf the air. Kiust winds are cold, or cold and dry ; iiorthf-rly 
wind** t'filil, and oftcripr ilaiii[t thiui liiy ; westerly wiruls arr*daiiip; !C>iiLh 
wiriWH warn). <Hinu-tinH'Hilainp, miinetinu'^ dry. Tin* iiilluiMKN> of windK ii])i>n 
th»» C(iniIition.t (»f smncfi-w healiliy pi'rson^, uiitl many persons witlt puttaonai'y 
discaue^ is very variuiis. 'I'lieir inllni-uo' Jipon Ihe ilevclnpmeut of (liiw--aMi is, 
howcvor, vi-ry oUhcn-e. With north jlihI easl'M-ly winda caUnrhsnre mado 
worae; palinonnry ili>i«<ji>ieK arr net npiliirini; ihr pn-viilrnccof any otlirr wtml 
OB Well, und (nirticularlv' un apring davK with Westerly winds, on colil daya 
with an east wind. The dry soutli winil of southern connti-ies culled J'ohn 
in Switzerland, .S*rocct» in ll;tly, Cfi'umrin in Kjrypt, i>* vfiy exhausting, and 
lua a jwcMiliarly evil iutlnencc upon new-boru children and new-cuincrs 
(iui migrants J. 

g. LlollT. 

The optic nen'r« may KulTer from (oo mitch and frfim too liUle ligltt; and 
cotijiineti>itis may also \tv produeed by dazzling by snow, or by sintd imrti- 
elen. Exeicdl or nianiHriil [»i'i*sMti« biivmie calm more easily in the dark 
tlwn in the light. W'u rannot iKwitividy »ay that light la quite iw neces- 
sary for animal life aa for the vegetable orgHuiKiition. It is true that ]ter- 
sons inhabiTing dark plaeoi, ileep valleys, that, cliamber workmen becomfi 
anivmic and Herofnlnns; and it has even bnm oJiMorttid that ercanimn was 
canaed by the darkncas of narrow niutintuin valleys. Such qnestiona ni-e 
not fM entity solviit, b(-(*«nAe many iitlipr influences, such as dainpneAH, in- 
sufficient fuud, etc., co-opemto to produce the result 

Wnsn^w, rAf/hf : it* TufinenM on lift and TTnitt.h, London, 18(17.— Tor the influ- 
moe of lij^ht npnti tho dflTolopmeut of vaiiuat iluwaMW ot the eye, particularly myo* 
pia, conioli Cmui. 

7%Q other iufluenc«< can be attributed to the sun than that nf hent and 
\\g\it, Tltis is very ini[iortaut fur the preservation of health, inasiivneh as 
the mnVHmenta of the air of dwellings is facillUil^-d by it. and by it the ait 
i^ k«'pt dry. Couvalesci'nt-s aiv alw.tyH very ot> in for table in the suii^Jiine. 

We do not know of any etlect of the moon n[H>n tlxe origin and coursH of 
disease. 

Tin- influence of weather and of seaaona ia made «p of the alrcHdy studivd 
Ctctnrs — heat. mot<)tnPt> of tho air, etc. In the matter of climate {vute infrn) 
we mu^ bewdile*!., take the soil conditions into account; and, besides, the 
kind of f<.><>d, <>Iolhing, dwelling, havu an inlluenoe which ia not wholly to 
be elindnatcHl. 

As iTgards seoaons ftud weather, the most important points have already 



Tim BOTL. 



(see p. r.O) Imwii spokti'ii of. SiuM^^n clmiifiHH aio tlie iuorI cflt'ciiial comli- 
tiuQH; itiiiii tlicro iH ail inoroii^*' iti iliu ntiiQUr of cn&es of disease i)i»ou the 
I'ocurreiiec of tbe first cold of wiuter (piiuumnnia, especially lii children 
niifl old {*ersnns) ; iu iIib Kpriui; c)m lirAt warm days with east atid uorth 
wiiulH (eatiUThK, pumiiiiainfi); the Rumiiier tiiun btiiig, however, pariicu- 
Ittvly (Luigi!nnis, if tri)1d iiightn hucoeeii vcrv woria day8 (choltsra, ilysea- 
t*^ry). 

In genpnil it may Iw Kaid. thul dainp, rainy, cool weather ia healthier 
than 6n<^ wpullier with ilry air; more aevore diacatws occurring in tho lat- 
ter couditiou. 

2. TUB SOIL. 

Tlie goognostic constitution of tho sort exerts an itiflncneo upon man 
jwirtly by the Ko-called aoil-water which itcont-aius, and |mrtly by the driidc- 
iug-water which Hows tliruugb it. 

AVherever thore ia not uinlf r uh naked solid, impenetrable rock, ve find 
vatiT under a uuinbcr of ponnis hiyi-rs of i^artli. This walt-r till* tho |»ore« 
(*f tin; strata in which it in; litling those in the lowest strata romplet*'ly, 
excludiiij^ the air wholly, and is (h^n cjiIU-U uudergrouiul WHter ; or, it lie* 
in clr>M; n^laticiu to uir aa it tlm^s just uhovn the snrfact; of tht- underground 
■watiT, in which tras*; tht- layers art' t^'rmeil inoiKt. 

Ak a rule, the UKriERCRurND watkh ih ronntl in grtiiter or less quantities 
upcru ili»; uppernioat Htratvtin which is impcrvi'^tu^ to WHt«*r. and ix nsimlly 
KuDiineiit to supply the wcHh of the locality. UmiuIIv it i^ found only iu 
n single Rtnttnin, thon^h wu not rarely meet with another (or U'veml) 
impermeable layer above the water, on top of which a moderate amount 
of water exisita, at least tomporai-ily — the so-callrtl stratum wal<»r. This 
usually will not snffice for tho fi-tdinj^ of wells, and often <lisappeai's iu 
droiithy Masont. In the making of wells cai'e is taken to trnverne thene 
aoureeM of Htratum waUT in tinker to reach the nuilergrnund water pro|Ntr. 
RvRU if Htratuni water be found in abundarice, it la not usually fit lor uk, 
being oft4*u contaiiiin<itad by iti< proximity to the surface. Tho depth at 
which undergnnnid water in found, varies from five to twenty to thirty 
tiietix'K and over. The inijicrvious stratum upon wliich it reals In usually 
a cinyry, moderately hard ruck ; upon I his there are hmmy and siindy layei-8 
of varialilo extent and thiektiess, interspersed here and Ihei-e with clay, 
which allows of the accumulation of btratniu wat«r; next there ia the »o- 
eidleil roller layer, niadM up of larger stones; above all lies the humiia. 
All these layers are filled with air, are temporarily or. as a rule, more ur 
less moist ; the damjteHt layers are nearest the underground water, and 
are Kfjuit-timea invadetl by it. The amount of underground wat^^r nt a 
given spot (le[»en:ls u}ion : — first, and principally, upon the auiount of atino»- 
pheric ]>recipi(ation ; Recond, upon the flow of water from hiyher localities ; 
an<l liiKily, u|k>u llie atucnint <»f water in Btreama, I^ixnil couipleto hIwhuw 
of water in due to hilly or wave liktj ujihtwval of the impervidtiB HTrnta \ a 
superabundance of water is produced by a businUke depifssion, itt which 
the water of higher places aeuuiuulates. The abuudanci* of water in a 
locality niiiHt uf nece-tJiity viu-y at clilferent times, according to the atmos- 
pheric ]>recipitation and the flowing in fi-om other sources. By means of 
repeated systematic niOAsurementa in various places, \'ariatinns in the 
nmount of undergmuml wnter have l>een observed, eepccially since atten- 
tion has been altraeted to tlii'ir int|K)rtanoe. 



The vatiatJous ia the ainouQC of unileripxtund water, which oon be well rtiprc- 




THK rSDKRQUtlL-KD WATER. 



60 



I for localUieii by cnrriw, with tolnmHly repninr abw;i»wtp, hnrc ninlonlitctlly fjrPftt 
inlliieiico upon the oritpn of (wrttun opiii«iuic diHeiuw»t, t'sjiLvially typhiiid fnver nuil 
Obuletu. For exuiiiiile. tln.> uiitnliiT ul' C[lv.'s uf lyp)iui<l fwi-r iu Munich (nnti nppnr* 
ently aisn in Ik-rliiii iDcic»t(-.t witli a iliiuiuulinu uf tliv uiultjT^nmii'l >yiiUt. kikI ili*- 
cnauem witli itn uL-cdiniilutirm Kjiidtimics n[ e1iiil)>m ithow ttitiiriM.'tvPS iimiii-'tUntoly 
oftrr a conwdiimlilo d-jiTn'ost' of anil»i)p^niKl watrf*r haa tak<m place. In these phe- 
QomctUk the importnnt fm±or ^r-^nv* to be, that the (UsapptMirance of tho wat«t ewts 
free a certain nuinbor ot injurioun <leoriinp(>Hitions of onfimic subntonees from tbu .vol 
■notst titrftta ; tbi^so pr<xlii-.'t<( Wiii); trikcu up by the air of tlie grouuil, an<l hy it 
tmnsp')rtc«l iat-j liiimaii il*i'llii)g«. It in iu tht hijfhCdt degreu doahtfol thnt tho 
umltr^niuuil Matur uuu dirvclly exurt, hy uirryiiig theM Kubstiuicae into the drinkiug 
water, a morbific influvutw. 

The ftir containe<l in tho groiiinl abuvo tlu^ giouiul-nuU?r Iiiyers, Dccitpiea, 
Hfl vre call ct>nvuicu oura'lvns wiihniit ii miniitt' exaiuiiiiition, a gn^at upaoe; 
it tuny o<|Ual and HUijtttMt oiit>-ibti*J uf the tuUl luuas ijf earth. This air is 
carrieil iipwanl iiito uiir liaKitatiurw, muw it is iievyr cuntiuiioiisly ulill. It 
in set in motion by evi;i_vt.hin«j which can disturb gaacs, micb ah guHl« of 
vind on the auHkce of the (.'artU, cbunjjos of ti'inpRrutiiix*, etc. And this 
obility of the groiiutl air itt not diiuinisht'd by the fiuzL'ii barilufiss v( the 
Yiitud i» winter, nincv tho change of WMt^r inro icv in not accouiji»niL<d by 
any lo«a of poi-OKlty. A couuideratiou of tbo rehitiotiH uf gruund air to 
heoJtlt, mitkeii pluia tiie great im|iortari(»' of Hunipiilous clfAnlinesii in 
tbti vii-inity of litiiiiuu dwMltiiit^, and the necessity of keeping the oiirth 
pun-:; pointjt to which Huch t-xli'Minilinary importance has been Httiiched in 
liit'Knt tirtii-s for lbt> ptwriitioii i>f diwuMTS. For lillby liipiiitH wliich penu- 
tmti* th<' gruniid }uuAt gradually niidergo decoiupoHition by chi>mic-al |)ru- 
o'wwH, and {five origin t« deleterioua gases, etc., whidi niay be cairioJ into 
bmiswtji aliiii"» with the ai-ouud air. 



It id probable that the spread of cholera from hnum to botiHe, in a given looality, 
occur* in some Huch way. lu Englaud it haH b<»n d>*mutuitrat«Kl on a larvQ euale, 
thnf HY^tf.nativ ptirificiitian 'if iJie gnmnd, by th« tmikliii^ of eowcrs, bikI by pro- 
tii tinildtn^f nt Kanktm or pit-liku privifJt, evert<'il a most b<>nRticial inllnenco 

V, ^icaltb. By thp<e nutans wm hroujjht af>[mt th« cessation of murderoa* 

epfi<-iiii<.-». and tho mortality conMqncnUy dituiuiabird by an Impartaiit amount. 

It ia probnbJa thnt the CO^ which is ranie abiindnnt iii the deeper utrnt^, 
drriviii fniiii uqraiiic priH-eHscH which tnke place in the soil. 

But it is not ground air alone which nets tut a cuuKe of ill health, fordriiik- 
iiig w.it'*r may undt:'r certain circum&tiuicei} excrt-au evil tnduence, or at any 
thIm it ia (ilVn iii>i without n'HH^iji siiKpected of being a ctntKe of dimnme. 
Tliifl in tbfi more [trobuble, if the water contain visible impurities, and ei^jkei'i- 
ally if it be contaminated by orjituiic Kiilwtjinei's fsewuge.) Not lews ini[>oi-- 
iant is tlie siiivhiiT^e of ealcaieuuii bait; tbi-s beLig the suj^pused cuuae of 
goitrf!, crBtiniam, etc. 

With fjwpect to g^itTG. we have the Btfltenipnt of Patxk relatinp to Franoe. to tho 
effrct tbut it oconra mure ettpi.-Hially upon Ibe folluiviug formntious ; the Lias, tbo upper 
new red Satid»toiie ; their eqiilvaJrnu. thu vark-^^ai*;'! SninUtouo. and shell -Unie«t4}n«. 
the Pcnniau and upper .MH>fiieaian strata. Oii tint oontmry, it vory rarely oocunt over 
|itimitivt> roelu. Kuch as gmiiit« ; on trnnsttiuii roitks, aiiuli ax Irrnuwacke and S«hiRt. 
the ni'Ktijtain lim'"*t'^ne, Carboiiift<niUH Ktntta ; uml alito hm («ulii(^m n]M)u mnri' rtn-vnt 
fiiruuitixuri. tiu* Chalk and grut'ii Sandstone, with the variouii members uf tho T«t* 
tiaiy <Jtoiji>. 

Wutrr of inrtrsIicR, when used f-u" driiikins* pur[»oHe«, most siirely prodnoeB 
bickuetis; forexatnple, muUri») fever, in some pimrcs of a mitltgnant type. 
Another «'ay in which tlie ground water operates injnrioiudy is by satu- 



70 



CUMATE. 



rating tlie wiills of hoiiRps, tlum prevt'iiting tli© eriti-Aiire ant^int of freftli 
uir ; in (>thi-i- w'()i-4l», (lainpiicsn of whIIk is it gt-cut liindi'aiicc tu vcntiliition. 
This Odiulitinii i.s in giVHt mrnhiin! the cause of the great ft-oqueucy uf ]iu]> 
tiiuimrv phthisiK in dump hoii»t'H iiml lucnlilies. 

This last point has been made clear, cepooially b; Gnglish Btfittt«& PopaUtione 
dwelling OD dry. sauily ttoila, iihuwod u Hmail piovalcuo« of plithlMs, whllo rl]o (liMaso 
was very cominou in iiuoplu Uvltig iipou a tluiu|i, cliiyvy ^rotiiul. lu llflcfu Ku};lifth 
towiiH Uti! mnrt:iliry Tniin phtiiixiH (HminiKherl fruni II to 40 per oeiiL \\t ntler doutg 
of the NuliKdi) hy inc:)r» of j>n»pi!r sfvrorikg*;. 

ICoiumlt H. L. BowditcU. VvMumplion in Xew England, Bobtou, 1862.— Eo.] 

Another interest ftttockcs to the rolI, that relating t^ its modification nf 
atmosphenc pmsKurc, of the temperature, purity, dotnpness, and the inovis 
iiiviiiH cif iiir, iiiid to it« intluence uiwn the nature uf fwiil. In gt-ufral, tho 
inhabitants of mouutaiuouii districts am stronger and more onduriu^: yut 
the higher we asctfiid the pooivr vegetntion appeal's, and miui suliurs ehiedy 
lu his nutritiun, without Wing uitjtcked by nuy Hpeciul dixtfase. Barrvu 
and bare el<!VAtt<<l ri'gions Jidvh dKlicatu inliidtitanls, uikI we thore meet 
even writh tut«tiuiltent fever ulonjE^itide of goitrf>, cretinism. 6ci*t>fula. Tho 
saniu is true of deep, olrvnt^d v«lh\v8. In low valloya then* is u gi^eater 
draiiglit of uir tht* Htndglit4.M' thuy iiru ; rheumatic oir^clioas pnivuil. In 
plaitiH the Irrigation is of us|K>i:i)d iuipoitAncc. In the neigh lxjrh>*LHl of tlie 
iMfu the tempenUure is on the wliole more uiiifonn; chilliness being more 
felt in many juirvailitig winds. The hculthiest residence is «ii(tn the ktuilut 
of K rupidly lluwtug Ntivum. The mist dangeitnis parts are lowliniiU and 
martihy ri^nuiui, and tliis in pmjKinion to the heat, ua in summer and in the 
soittli. In such regionB not only intoniutt^mt fever, but also choh^ra, dys- 
entery, and CAtarrhal tiiarihwa (e«pecirtHy in children), occur tW|uently, e«- 
jM»cially in now-*x>Mier8. There is speeiat danger in uucultivftied r^tgions, or 
where a previously fertile, peopled, and healthy section is desolat«d. 

3. THE CLIMATE. 

By climiik' is undet^tooJ the suin-totwl uf all iuHucnces derived from the 
Rtruosjihen? and soil. It is pussible, from w eonsidt raiiou of tht-se phenom- 
ena, to TnaJce a toleraVdy accurate estim]it« of ilie Rahihrity of a given cli- 
niat«. It is, however, further neci-ssary to know fh'? mortAliiy and mor- 
bilily * of a locality in oinler to pnicwd upon (lerft-ctly safe ground. It 
is further to lie noticed that the totality of nuiive inlmbilants tu whom thu 
niortnUty i-eport« refer, is often piwentwl by other Uinn climatic condi- 
tionif, as social or political influence, from sharing tlie ailvantflgea of the 
cUniatt) ; wheR-as an iiide|>em!t>nt fitreignt-r, who cah pnK'ure the l>eKi lodg- 
ings and f'j<»d, obtains the bum'litof the clinuito and itit healthful iuiluouee-s. 
This is true uf many plucks in the suutli. 

The chief influcuce uf the oeeun upuii clininto ooiiHisin in its nioilf rating 
tite heat of summer and tho cold of winter (the so ciUIeil marine, or coast, ur 
island elttiiHUf). 

The chief inflnonces of forests upon climate are that wooded reginns hn>*e 
cooler summers and warmer winters than those deprivetl of wocmIs ; tlmt daily 
variations tiflieiit ace lew* in fonwl-i ; tlmt thu fori'sls so modify ovap4truLtun 
from th«' Bull n4id Itavt-s, that st»tioiiary strtita of air just abovo woods are 
warmer timu over Ihiitcu soil, tield or meadow. 

* The Oorman word morbUitat U so correct a name for the oondltlon that we van- 
lonj to offer its literal translation aa a new Knglish ini^cal icrnL — [Kd.] 



URDICAI. OKOORArHT. 



71 



With rc»|i«:t to Uwir |»eculittrities as niljuucta to mciUcul treatmnnt, cU* 
nuit4*si huve boi'u divided into: (1) Alpine, (2) sub- Alpine, (3) midiuud, ur 
iiidid'ereut, (4) nuirine cUmattis. lutu tliiii claiwilicatiou there enter tito 
grvut (ncUkrs of atnioM|»liertc pi-ewiiirv, Imnt, nnd uiuisturo. An Alftinu cli- 
niat/.' may he de^igiia (<■<:) as cooi-drv, tliu sub-Alpine as cool-moist, the mid- 
land Mn wtii'in-dry, and the marine climate as vrarni-moist. 

A [MTsun iicginning to live in a clinntte new ti> Itini ctutil^ beconieti ill. 
The ai.'lximation diseases, ho callnd, ui-«*, itpait ft-uui undi-uiic and iulVctiouB 
diAeost^, ueiu'ly alvcny:^ gustnc and iutustiiiol catarrhal atTections. 

A aeir wieDoo. medical oe^ighai'IIV. han nprang from oi.niATOi.onv. I'ha g«o- 
grapMcs} dlfltribntion of <1iseAsc, if fttiidifftl in relntioa with itn caunov atTnrdii im- 

I -all* in j-aitliiiloi,'?. in aitiokiRj'. iJi'I thKrajwutic* CompaTe AirHHY. &*ii'- 
. t'ntMtt,urA . IH.I.S; and partiRnlnrly Hiltwcn, iUtmlh. der /u^hT.-f/anjraph. 

/*,,/,.- . i<<H (L 1N.MJ; iiornis. (ifvt</. iimticitU, void, il, 1850; BU'WiUTT, VUinai- 
f^ffjii "f Vi< f. ••iiiT'l Stittd, I'bil,^ ISo*. 

i" fi.ihtv of m du-tiict lit Ui Ik? lueosurwl 1*t the proportion existing,' betw€ii.<n 

I ' iliMi.hn anil tin: number of iiihAbituuta. If, for cxuuiplti. » oitjr bu 70,0(10 

II —. mill 1 ,'tW pi>opI« ilie in il ench ^tar, vro aay IhaL Una citjr luu u inurtal- 
i^y ur i.OOO ; 70,000 = li ; TOO = 1 : -«t.O. 

There oooun Ui the north of Europe 1 death for each -11.1 ijihahitouts. 
■' " nuddle " 1 " " 40^ 

" *' Bouthem *• I ** '* 38.7 

For rate in Tariooa oonDtriea and cJtaea, ana p. 35. 

Amonff the diaeaaoa whiuh prevail in more or leu limited terhtonee an the 
follow iuK : 

The Pi.AatnB, that is, the orientftl boil plastie, which makes tte appearanoo on the 

I Hhore« of the Hc4lit«rmuonji. particularly in CooMtontlnoplo nnd Cairo, about 

' teu or fifteen ,vear«. Thu diaefuc doee uol pruvaii in summer nnd but wvatbcr. 

t alway* ceaattie in Cairo dnnii({ July, ouJ Iuim never piiuttd the sonlheru buunJuiy of 

_ pt, the Bnt cataract uf the Nile 

YbLUiW PKVEK, on bunu- <Iiu.>aMt! chnractcriuxl hy vomiting; of hlood, juimduxj. 

frrer. ui endemic in Soiirh Amerioft and tlie West Indiei, being nuciixiimAlly 

1 by means of vcsh'-Ik to Leghorn. Genou. Liehnn. requires n tf.niiMrrnture 

of 23* C. for its development, ia found mure u^Km th<9 pliUiix tiuin n|K)n monntiMnii, 

yet may ot-ciir tit an nliimdi' of 2.00U ft-ct anil muru. [It pri'vailn almuMt every yeiir 

UI the Soul I . ' of the Uniuid Stuu:** : GalvotfUiD, New Orleatin. Untou Uou^e, 

Mobile. f'> h.irlc'tOQ. and even Wilmington. In a few Beu«<^iuB this tJiaeuao 

was !riui*i''i. L. .;,tltiui')ru, I'liiloili'lpliin, New Vork, luid even Ilosl<in. — Kd. ) 

TvniiMD KEVEii, prL' vmini'uUy a illifasc of the temperate zooe, apiK-am Ui the 
imrth iw wull. Ijut iit ttierc a much mUd<;r atfection, tt in to be found al»o iu the 
Uirrtd fonp. but ix thnre complicated by allied febrile etntea, vhoee anatomical 
cborftctcm have not yet Iwcn ntmlicd with precision, with the exeepcfon of the 
biliouA ey|>beid fever of ISf^ypt. which la aoeompanled by hajmorrhaito In. and InHam- 
matiou of the hver. aideuo, and kidneys, and which dues not exhibit any iuti'HtimU 

BiANTHKHATrti-g TNTtlcs U [KX'^onally Ml Widely Jipread oa typhoid fPTer; it is, 
hrwm.T. mom r.wt.ricted to nortbt-ni Intitndes, et^ectully in North America, Great 
Britain. Hwfden, the ftnulan UnJlie provinces. 

MA1.IONAHT (i:oNUBSTiVK) iimuiu irrKNT KKVRit la to be mct with fn HaiiBary on 
Uauubc and Tbeim, tu It«ly on the Pu, njHm th« entire weat cooRt of Africa, in 

my \tartM of the Uniteil Statea and Cwuini! .\merira. 

CniiLKUA in nccawicimdly met with evfry where. 

DT&fi«TKitT occurs overywhr<rt!, but ie copeoiaUy tevere in the aouth. 

8i.<iliiJi:Tl» i* a diiMVuie of nurtin-'m climea. 

SCBO^TLA appears in tlie uurtbcm iiort of the tcmfHiTatc zone. 

TrBKKcn.^Hlli nhovm iUvlf tbrougtiQut the inliabited porta of the earth, bat is tn- 
eoDtptrahly mure fruqneot in the t*.>mpf^rat<! zone, ««]M>t;iAUy bntween 45* and 6G* 
north UtiluUe, tliiui in the north or south. In all climates it is meet oomroon In 
oos uitiea, wliere huuuui hein^ are crowded togetliei ; in the oouutry, and in 



TIIK nWKU.TWO. 

thiiUy-I>eopled cntintries. in tbe Steppes of KirKi*. in ronntricg wipprmnflpd by 
lieBorU, »aoh as S^y^i, Monjcvo, iis well ofi in the itm^inn HalUo provineus, it u 
cxcL'tKlin^l^ roi-u ; iu St. PoLCKljutx it ofpifu bciximcs comuiou. 

A chango of diinaUi cxurU u favorubk' lutlucuee upoii paticnU Bufferiiig 
from all kintU of cliext duteiuwtH, rbenmatixm. anR^iitin, aud upon ooiivak«c«nu in 
prnpnvl, when they t;a to a warmer, (ir mor^ csjiecinll^r a mom oijuable diinatfi. In 
Uennnny thti (oUdwiut; retiortJt m»y be namiMl : Wie!<ba<1^u, bn<leii-lt»<b-ti. Itwlen- 
wt'iler. IWitzcn, Alnran ; in Italy, Piaa, lioiiie. Palermo; in Kranre, Tan, Xice; in 
Africa. EjiTpt, Alginra, Madeira; in the Coited Stat^^s Mimmsota, Colorado. New 
Mtuuuo, porta of CaUiomiiL, JocluKtartlle (Florida,) Aiken (3. 0.;} Be^mIldI^ fianmoo. 



4. TUE DWELLIXa. 



The dwelling inay be conaidercd tts a sort of private climate, which is 
VDluiitarily liiaitctl. It is of greatt^r imporhmce i« healtb the more the 
inhiibiumt i-t-iimins »l liome; mure inipnriatit tur the northerner than for 
the :tnnthi;rner, who n'lUAtiis more iu the ojieii air. E!i|*ociulIy iti*ti-wurthy 
arc those buildiugii in which men arc coiigregiitett for a lung time ; fac- 
tories, hotipitiiU, schuulK, tlonnituries. Kvcu healthy iransons upend a good! 
thiit] of their livi<N iu the lust- 

The chamcteiM of a good ilweUiiig are : auSicieut nize of tlie room^ u|>oni 
whieli Jcju-ndti the purity of the air; drynttss of the floor and the walls, 
and lo a certaiti degrte of the air abw ; an exposure ill our cUuiale, when 
pOhsibJH, U) the eajit and south ; gooil veutilatiou without oonKiaut 
draughts of air; location iu a. heulthy region; the proieetiuu of hliudti, 
eU\ 

Fixtth, pure, Uiat isj oft-rftnewed air, is on iniportnut «f«*iV/*m(«« for 
sick ami well ]teni>iii», particularly for Mich as are obligi>d to a^K>nd many 
hnunt daily (in schoul-vcwuns), or montli.<4 and ycArs (orphan asyUuns, gar- 
risons, pmons), iii the aanie building. The air becomes impure by insuf- 
ficiency of the s[>ace in which the huuuiQ beings remain, by the want of, or 
by iui])crfcct ventilation, by iujuriuua meduudeal and chemical admix- 
tures. 

TJie size of iJie space needed by nmn. healthy or aiok, when living in an 
incloflO"! place, cannot be determined with absolute acoumcj'. The average 
bus 1)oen vniioualy placed at 300 (o 800 cubic feet, in dilferent oountrie«, 
and under very vai-iou-i conditiou.s (in luirmclcs, hospitals, etc.). 

The size of the sjiace is of com(»aiafivvly less imjiorlance when a careful 
and regular veiitilatiuu n^newft tliu air in it li*om time to tiuw. 



I 



Tb liA« been determined by experiments upon respiration. IbatamaoneedBUKcobio 
tnetrt-s (lU(t-l70 cubic fei.t) uf tipuuo in cuuble him Ut bruuUia iin honr wlUioub being 
lajuied bjr Uis own car'onnic uciil. ur by the nmifaoUuu rif the air. 

H. htui been tipcciully nocertiuntvl that each child need? l.ft cubic metre ; 
tlitti eaek child iu theoomitany of old pcrople neeil^ -1 '* 

ttint each adultiu the oouipony of old jwrpie neeila S.O '* 

ThiniHCXcitisive of lightJu? und hc^ttiug. which cuusumQ muoh oxygt-u : and in 
tbo efitimaiu the apau •. .^uc-upiud hy the furniture iniMt be takun into nccviunt. The 
number of buurM dari t; which u Hp:ive in tn ite nved, mnnt dettrmine on inereasa in 
every diuieuxioa of th t ^tjKiee. ko that for t-xample a dormitory for four porF^ma huld- 
ing ul leuMt '3(H) cubic ini^trcM of air, with a height of It! feet, ihould be about 2-t leet 
lougaud lb wide. 

The evils inherent to smaller rooms are deficiency of nxyp^n and accu- 
mulation of carbonic acid. Ah the rfTocts of them) conditions ar«i bat 
gradually develojied, it is impossible to name any particular dUeofies, bebidea 




ISE DWELUNO. 



78 



anirmia, Hcrofuloaia, tuberculoids, to wliich tho inliabitontB of small dwiOl- 
ingH are lialile. 

Tli«? i>'iiuiiniiig gros-H iiiipnrkifH of air cuuHe for tho mo»t ]mi*t debility 
or irrit-ation uf thi; nuictais lueiiiltrttiie. Aiming tlii-.sc tu-u to W iiaiiicJ bui- 
pbuppttri] liyrlrogf'Ti, hy(ln>-siiliihurclrr<l Hnimniiitim, ft*ina »mrimniji, wliicli 
ahnund ill water-cIos«ts an<l privy-vatili*, as wvll iib in kitclu'ii sowers, nnd 
■wliioli, esitecially when the tlwclhtig in heHtt-d, ascfiul to the rooiiia; oiupy- 
rrtiiiknttc i>tlH (liiritig tighling with ill, iinjH^rfi-ctly burning Hul)HiaiK'i>H ; vohi- 
tile itciilH from huiiiiui i>r mumnl cxhulutions ; oiirbouic oxidt;, which beuunilNi 
at the (levvlu|)inritt ot' amoke in coiil uonibuatioii, aiiJ quickly kilU ; car- 
hoiiic aciil (hi'c* p. t>5). Strong miltstJiiicieH in a st*it« tit for iiihnlntioii, such 
us tiiL- pfirfuiiie of many tluwfiti, uru ii^uriutiit tu luany pi-rmjtiM, particularly 
tliotto uf a DiTvoua dispoMLtou. 

Afvnrtling to Pettknkoitf.r. to whom ve mn many renenrohes upon iho ()noAl,(oa 
[>f vent.JattuQ. Rn average inna ex|iirea Qooh minDte A Utres of nir. which couUuil 4 
perocuU of oLrtMniic ncid; iu each hour :i(M> litrcn, inelntlin;; 12 litre* of oarUmio 
■cid. Tliat alt alom; U hudlhy which, alt«r thu mjjouru uf urn iu it, ooutaiufl at Iba 
bi'irhen S iiatti* per tfaouBtuid of carhotiiu acid. Iu unler lo Kt-cun^ tbo ihurouffh 
rvDnvntiiui of the otr in th« inclosed cpace, » liirgu nmonnt of frntth itir l^ iiPoeiMitry, 
In order thnt the kir nfannlO mmtun gontX. it i^ nocnNnar^' that there alioultl >»e iutro 
iliu-«xl at each moment lwi>-huiii]nHl timcft tho vultimu ot Oil- ex{ilrt.-tl air ; :iiii1, na a 
iniiD expirva about !!00 Litres iu on hour, there must hourly enter l)(l,tl(HI Ul.r<'!t nr HO 
<mt)ic mt4tn>M of fn^h air. In rooms where nick ur well [tei-noiu* Atay for any lenjitli 
of time, thin in tn l>e Hcaurod only by meazut of judictouA Tentiluting' appUanixM, ti(.>*ft 
tiy the direct entrnnce of fresh air, nob n» well hy removal of the imi>uru air. Thia 
parpoae ia attiuncd by the uonstant opciiiug of niuncroiu and laT){o windows, aa iu 
th* American pavQiou aod leut ttystetu. 

pBTTKSKoyK.B hiw futthw showii tliat the dry woltn of our lionw*. jiiirticulurty 
thoae of brick, and alita thorn uf mg-nUme |th« latt«r |iartii(Uilarly whtm plnHturetlh 
are twnneable to the air. and thtit lime tmd (gypsum phuilerlnj^. and oil painting, do 
aot {ircrcDt thiit jtcnctmbility. The innumerable minuUi porcA of the w all. by uieoua 
of which llie air in tli«; room coRiuiuiik;jtCv!i witli the oiitaido uir, allow the enlranoe of 
mni:h mure air thim una come in throut^h the leak^i nnd cracks of dofim and windowa 

f?6n' inipai't of air uiKin tlio exti'rnal f.ico of n wall caused n movt^urnt in the air 
«■» inner face. The auioum of inu-rchanye of uir thruiijch the wall depemU 

ifwctally upon the difTtirenoe iu the ttmperatuie of the atmu^pherc on tii'i uut^ide 
aod on the inude : the ifreatvr this in, oh for exani]tl& m the eol J winter tiea- 
»iu. the miiiv air onten and leareR a dwelling in Uiiii way. The ixinxiity uf walU ia 
ilL»tMiyed at oai*« by wuttin; : huilce the difliulvaata>'eit of new, Ill-dried dwuUinjfs. 
N'Atural Teotilatioii id somewhat iaoroased by open Bre-piaco hcatiu); of Tuoms, bat 
Dot tery much, an ii lutually amumed. 

While n oertiiia numb<>r of noxioun goaeii exhibit Hpeciflo odoni, or produco nn- 
l^coHont MtnciUniM iu the mucou.i membmnes of the eye, larj'ox, etc.. there are 
/fiUien, liA for examplo oarbouic ocitl, carburett«d hydrogen, whioh ore not peroep- 
ttblfl to tlic ameU. 

The umiincv of bfsoting, of airing, the elosure of wiiidowH, tho caro of tho 
inirruuixiingH of the botiae, et<:.f belong to livoiEXK. Dwellings with dainp 
grounds aud walla ai-e above all dolcteriMua ; they are colder, ilioir walla 
aru lens |ioroiLS tliey are fuvorublo to the ocotiri'cnee of putrefaction nud 
uiouldinesa, and tho moisture of the air itsolf may act dir^-ctly. h is coi^ 
lain that rheumatism and neuralgia follow upon the operation of these 
caufves. 
llie groateiit demand for reform conirfi from public institutions of all 
ids, all public offices, orphtm or foundling arirluias, lying-in hospi- 
, hoM[>itflJi( for tho insane, general hospitals, aJmshouhCK, and |in8ous ; 
fcauii* into thew hnildingti mo»t {*er%unti go iiiiwilliugly, and because the 
which in a mttuuer despotically lodgea thcu, is in duly hound to pro- 
'rtde for their health. 




m 



n 

In making plmis for hiiiUlinj:^ the following allowaaoe of ventilation pw 
{M;i&on, per liuiir, sliuuKl bu ruutlu. 



60-70 cubic metrei 


in 


hoHpitala for ordinary cast-s. 


lUO 


14 




u 


*' ** wuiindml [wtii-ntH 


IftO 


M 




u 


" '* epidciuic diBcaaes. 


50 


LI 




11 


piisonAL 


60 


(( 




(t 


ordinary workhouses. 


100 


It 




u 


workbuiiBttt for invalids. 


30 


U 




It 


day Wrnitks. 


40-AO 


it 




a 


niglil liaiTiickti. 


40-50 


tl 




tt 


theatres. 


30-<50 


tt 




tt 


aaaembly rooina. 


12-15 


U 




II 


achoolrooms for ohildreo. 


26-30 


it 




a 


» " adulU. 



tJufoTtunntely these reqairementn are not atways fnl fi Ugd, even in enlightened statM. 
ThiH i-H mum L-h|iAcEally tiiin of iiHfioua. Tliv \prinit mortality in ibciu \h in part ihie co 
unnvc"id»*>!t! cjiiim-s. Ou ibu nvonitc il iiinouuU to 1 : 20-00, in pttrlicularly well-man- ' 
aged Lnnttttiliiiiift 1 : -to, which iit higher than the general nioruUity. although thers 
aro no new-born children which Increaoe the mortAiity ratio so much. The niont 
comnimi <lihcaHCi9 uf prinouurs ore tiibcrcmlOHia, pneumonia, typhoid fever, mental 
affeotions. The food aud^c kind of work of ouurae plU|7 a p«ut in incrcomnif nioi- 
taUty. 

The mortality of large ctUes is larger in siimtner and autumn tlion that 
of the open country, ami in winter i« u Utile lees. In large cities the inha- 
bitants, at least those without means, stifter from crowded dwellings. Be- 
sides, hitrin is dime by the einanatiunn of the ground tipiMi which the houst>H 
are clofsoly packed, and whose subKoil is auturuted by tlic Hltration of 
human ejcci-umoutA, with orgiuiie putrid ttuliKinnfeH, or witli couto^oua ma- 
terial, as for exauijilo that of cholera, lyphuid fever, etc.; by the absence of 
vegetation, which cleaiH the at niospltere of siiperubujidaut carbonic acid ; by 
t]i6 air sljtgiiHling in narrow Rtreetn, by il.K making utreets turn cold, or 
warm and moist; nmoke and dust are present in large quantities ; food ia 
often adultei-ated ; aewers become dangerous if they carry off much refuse, 
0(»niet**rieH, slmiglit4;r-houKt's, gas-houses, if they give off bad iidors. t)n the 
other liiUkd, wellguvenied lfirg(> citie» hn^e theae advoiitiigeK, tlmt aauitnry 
rcgulatiotiit aie better executfil by the authorities, and tlmt iu time of iii»- 
trosa help is nearer and ia more freely given. In sumll towns and in the 
country the indifference of iiRJiviJuals toward ordiuanee» is ntsnally 
greater ; ]il)yHiciaus and inatitutiuOK nie ikot numerous enough, and the di»- 
adviuitagCK uf the locality ajt^Mmr at tlioir worst. 

In tho Inst ten joan the morbOity as welt as the mortality of many huxo diiea 
baa been ilimiDiAhod. by the eitHTtion of wot<*-r-workii, by Kuitahle Mwemirc (partly 
throngh the ao-caJlerl Hmxl-canal aynr^ui \fkfiieiti4tTu:i* M/i(i/-xy'^7»J, and the water- 
dcwet iiystom, with air- and water-'U>;ht traps). 

5. CLOTHING AND BBDMXO. 



The clothing with which civilized people and the northora 
themseLvi-H, is to be studied from the following points of view respecting J 
UHefoIness or injuriousness. 

Our bodily frame ia to be looked upon as a warm and moiat body expottad 
to the air, which loses beat in three ways : by radiation, conduction, and i 



CLOTUINO AXD Bia[>DIN'0. 



75 



flTtporation. By coTering the skin with clothing wo pi-eveiit ilirect loss of 
hbat, mill (liuiiiiisli the euutact of the air witli the liody surfitce ; w« cnusti a 
diuiinishoil los« of heut in all the three ways. 

A greut advantiige uccruHs in the liealiiig economy of the body from tho 
fuct thut hcitt i» not lust in only one way^ becunse the action of tht* twveral 
lucHlts rouJera possible a ilelieato rugulatiou of the loss of lieftt. What we 
lose by one way in equalized by diminisheti loss in the other two wbvs. 
On the nverti^e the loss by iiidiatioii unU conduction in tlie rao8t contttuui 
undnr nimilur circtniiHtuncHH, ainl the eva|»i»rutioii of riiuistini^ in the nioane 
of partly bnlaneing the dilf'^'eiices existing in the amount of heal produced, 
as welJ as tho errors anised by functional disorder of the other channelH. 

Th»^ los« by BADIATiuN may l>o a very important one ; tifty per cent, of 
the total heiit being usually 5eparat{.*d in this wiiy. Thia loiis incieusca with 
tha dilTeronce between the teni[jerature of our body and th&t of iJie itur- 
rouudlug mcdiuxD. 

CanMeqaently, we feel cold in a room which is ant wumed throuphant, eRpeciallj 
lit iti )K4ri|i)ier7. thon^fh the ulr near an be at the pleiuuiut dognxj vt 2U' 0. fiadix- 
tioii ih itl.»o iioUiUly dimiulshed whcru uur boJ; im tiitiTOUDded hy ubji-et« of a niniiJar 
lcui]tt:r>tLtu:t;; tu) fur ux^iuph*, m a nimuu crowileil wiUi liumiui Iti^iii^'s. ur ui n uruw'd 
m ihv oi^ven uir ; anil wu feci warm tuderimch conilitioiw, even if the thcrtnomotcr 
Kbtiwti l>ut u Tnodorate degree of hcjtt. and thin b<K:auM onr neighbor uro tta ivnrm ofi 
owelvm. In compoUAatJon for dnlici^noy of rni^ntion nti begin to pornpire, and try 
to cool ouTBclros by tacuiui of fans, the beat envaiihit; by tho otbcx two wuya. 



The hj8» of heat by cONlnrn'IOS is also iinportjint. So long as uur body 
is warmer than the air which fturrouuda na on all sides, so long does onr body 
heal it. No equalization of temperatiiro can, however, take place in this 
Way, becaiTse the heJtted anil rarefied air rises to a fliKtanu^ from the body, 
is replaced by colder air, which in its turn goes olf whf n heated. 

Thin afKcuiling air current may be ao etrong aa to Influeuce tho uingn of a sensiUve 
aneinoroetar placed beueath th« olothua : tbia being a uuneut uuuouccd by tu be- 
oaoM oar tterrea cannot apprfoatu air in motioti at a xputHl uf half a iiiettv {>«r 
HOand. The Ion of heat by onnHuction becoinf>H iniiith niori^ ini|t<>rtfuit if wn ttx- 
ehan|;e badly^cond acting air for one timt is Hiiglitly hcati'd, or for tlit; miich better 
coinim-ting mwbuiii watrftr. Whercan a-e can comfortably remain in luoilemtely 
warm air with only light clotliiug on, we are very cold with the same dotliuig in 
water of a similar temperature, idthough in the Itttter case hMw nf ht-nt b; ('v.-it>(>ra- 
tioD has whoUy ccaaed, and the loss by radintioii is reduced to a miniiutim. C<h>1 
botltft uau>)V a much greater 1o«h of body heat tluui exp>.<ini[e in an. equallj cold almoi}< 
pb«-vc. In Lhu o|iim air we lone much more hwit by CLiudiiL-tiou than in rt room, because 
th* nioTemtutj* of thr air are much diminUhed by thi; wiUls, aud cauwiiuuutly a much 
tfwiA quiiiiiitr of iiir pu'vi'^ over ux in n. giv«n timt:, in a room, tbuii in ihc apvn air. 
Tiie initiiinum of lioat loat by conduction in a room miint be compcnsKtcil hy lim 
frjm fudiiitiou and evaporation. By the u«e of a fan in a room the volume of air 
paasiiig ovto' UH u iucrea^-d, aud vrith it the loaa of licat by conduction. 

Of how much importance evapokation is for the cooling of the body, 
may be inferred from tlie fact lliat one gr-amnie uf water i-enders latent dtiO 
heat-uuiltt in its pasaage to the gaseiius form. An iiulividual whilb inactive 
will lin«^ in thifi way according to exijoriment, 'MO grammes of «at«r by 
the latigs and skin--tluit iu, 504,UUU heat-imita ; oue exciting bimaelf 
violently, 'J,iHiO grummea of water, or 1,120,01)0 heat-nnitJi. This explains 
why thf blood never IwcomcB warmer, in spite of active oxerciae{tt[mrt fi-om 
a cert«in excess). Tlie orgunisn) brlngu about this result, in so far as it 
couceruB the &kin, by the changing uclivity of itj» vaao-niutor nerves (vari- 



T6 



ctormjio 



BDINO. 



able according to npod), by means of which the nioi8tni*o of the sJciti \s 
(iiniiiiiiihwl or increased. So long H8 we are &nrrounJe<l by air, there co- 
incides as a nite, with a gri'at^r h>KK (»f heat by conduction, iin inctx'nKcd 
evaporation at Innxt on long an the ciiculatiuu in the sktn renmtnx ai-tivi% 
and the air is uol wholly saturated with moisture. ConH(K{U(*nity we be- 
nonie vool much more easily in a dry than iu u inowt atmosiiheru, becuiiae tho 
saturated air cjui no longi'r witluhaM- heat from our bodieH by evajioruliuu, 
while dry air dot^s this in an exti-eme di^rea 



viil- 

Ob- li 



Vary Eator»tinp aim a the oooling of the body liy re^ptratjon in air nf varying 
totnperaUtre and moisturo. If we net tlown the volume uf air whioh an adult todiviil- 
iial in- and expiree in tifcntj-four hours at an average figure of [t,000 Uuvs, we ob- 
tain the f>.jUawit)]j; liy cnlcnlation : — 

Ad adult loaes in tu-c nty-foiir bonrs by the br^athin^ of: 

Air at 0" 0. (drj), 2J»3,n4« heat units. 
'* 80* C. (dry!. 274.000 
» 0. (moist), 20S.050 " 

'» aO' C. (moiat), 105,3»0 " 

That iato say, that the loss of heat is Tnnch more important Id drj air thtui !□ air 
aatumttid with moisture^ At a tempcmturo of 0' G, at the point uE couiijlct« mtu- 
ratitm, tho Umjh is about 38,000 btat-uiilto, or quitu 10 per cent. Il-m-; and at a 
t«mprTalaTc nf Hi)' t.'. at the point of complete «atumtiou, the h>»4 ia <n p«r cent, 
less than az the point of greuteat drjncss. 

Dimth is at laat brought abnut by oxtrpmo loss of hoat^ and a dejjree of 
fltich a loss, beyond a cortain t^ndumblo limit, givoa rise to diM-aiif, by cool- 
ing. The increased luaa of hr:at may affect tlio whole or a part of tlifr body ; 
OB for exiunple, when we step into a cold room when coverei) witli [n.*rspirii- 
tivn, or whrn we remain much too long iu a cold bath, or if we sit near a 
cold wall, an o[H3n window, etc. 

By nn*nns of our clothing, wo receive back, after a while, a part of tha 
heat which withuut it would radiate fix>ui it to otbur neishbtMin^ b^iliea, 
btsrauKe the Ktrilfit nut of which it is made aif not diatliiMinaitous, allowing 
heat-raya to paaa througli unabsorbefL Still, the heat ubsorbod by tho 
Clothing may i-ndiHte from its outer sm-face, just aft it might radiare from 
the uncovered akin. " Our clothes fivexe for na." The pa^Kage of bent 
through tbia covering depeudif esH^ntially upon the condnctibility of the 
t'litth, and upon its tliiekueKH, t.r., upun the distance whiuh the radiating 
lieat mxut traverse in oitler to reach tlie outer sui*face of tho clothes, and 
\ipou the lime neccBsary for thw tnuisit. At the Hinif time wh Iniat-, by 
means of tbia heat radiating fixmi the body, the immi'diate Mirruumling 
of our bfuly, vix., the sli-atum of air lying Vietwiten the skin and the cloth- 
ing ; nud this is constantly done in a greater or lesser degree, us uee<led 
to ju^tect our uerve>ternuimtiouH fix>ui the uupleaaaut or injuriouK effect 
of sudden changes of temiterattire in thnir innnediut^ vicinity. We ihos 
lose our boily heat through rightly chosen cluthlng in sucli a war that W9 
feel comfortable. In proportion u±i the loss of hent iurreaaea, while the 
internal prtKluction reiiuuna about the same, wo experience the necew»iiy of 
allowing tho escape of heat from the vicinity of our laidy to take place 
mom slowly. Then, if thTOush the indefW-ndent activity of the vaso-motor 
nerves of the skin a marked degree of restriction of the loss of Jieut ift 
brought about for a certain time, the repreatsion of the jieriphenil circula- 
tion no longer aufticea, partly because of the exImuKtion of the Tii-rvea« 
partly biMaiuRe of the amount of loaa. Supporte<l by a lirge ex|HM"ience, we 
then put on iscvcnd articlea over one another, and wliat hup|H<ned to tha 
skin wben covered by tho first set occnrs to the aecoud set uf miliclea, and 



j^ 



CXOTIIIN'O ANT) DEUDlNa. 



to the third; with the iiicreafie of Ihf i»tiiiil«'r of clotlvwi there ib an ciddi- 
tiou of waiTHCtl laywa of air iu the iifijililwrLouii of the iiervc-euiliugR. 

CIotbinfT cannot be defined m nrticleK destined to keep the air awny from the 
body, for, on the contraiy, wo wear uo ''lotbos which do not olltm- of a c<int.tiinAl 
TCnlQotimi of the mrraee of the body. The KtiifTa whitrli unrvi* tn miikc rmr warincist 
dolhinur ate munh mor« fiermoaMf to lur than Ibiw which vre r^cNifiitato a« cool. A 
current nf air la runntantly px'Ming' thniiigh tui; nlothing', the Tohimc of which. M In 
cfCTT kiud of TeDlilaliou. dcjmnds u[ion the xizc of the aiKirtnre^. upon the di'gree 
of ilifTiTv-orL' helwir^u the air withiu aud that without tho dnthin^, and njKin the 
Trlocity of tht' air nlxrut u», Cluthiiijf tfiiiiH-Ts the mmtnct of air with our hody, 
fTT!'- <i - ■ - Trntini* thfl irapinpiiig of the air an a moving body «4jaiiint tlic- norri:^. 
' -o rcgiilatM thp tompf-'i-atiire of the air by cauaiu^ il to umuiuk a mcaa 

<;■„.. 1. .i'_-at by i>a.«Aini{ throii;,'h the jwrcs of the cloth; a myan of 21 to lift C 
'* tte carry abuut os in our clothiug iu thu oiwn air, «yvcn in northern rcKionn. tho 
air of the i>oiith. We feel in this jnxtaii wc should fci'l stajidiiig nak«d iu a perfectly 
calm atnioKphere of from 24' toSO'^ C." 

Aooordini; to the inveMigationf of KRiRnicn (ZfitM^r^ /. Pvihffie, V„ p, 47ft) 
there it, l>tit liltJe d!tft.-renee between individual sabatanceii in iheir capacity fur mdia- 
ticm. KlttK<:i':i* fllliHl a cyhndor of tiu with vsann watar, HurruuDdod it with variuiis 
kiudi of clotI.li. iu various wayt>, aud ur>ted the diminution of hciit nt 8tAte<l lutvr- 
raJa If wool Ite put down nx ^l:^v'mg a capacity of IIH), then that nf chatnoui is LU0.5 ; 
Bilk. l(n!*>; eiitton. 101 ; aud hneii. 102. 

The cdlnr of the fahria is aI»o vrithout eneDtial intliicnce upon radintlou. It in 
otherwise in the matter of abwirptiou of heat by differently oolond clothji. And 
indee<l iti thiN rci^pcct (ahnorfitiiirii. the dJiTHrence in tiie saiue colorv, betwceu dlfFer- 
pnt l*"Xtiu>'s. IK mft iiu|Ku-taiiL ^oH'.n. llHi; linen, Oy ; tliinnel. 102: silk. tOH), 

a'-' ' ■ '-' '! for the name fiiliric iu various colors. In dilTereiit cttloted fthlrt- 

I ■■ \-i nbM>[irtiou index uf white, that of imle yeliow ij* 1 C^i ; dtep yellow. 

1 ■ . „ . 1V>; deep (rreeli. ViH; turki.'>h-red. KP; [lale blue, lUy; hlnck, 

SU'v I'lK'-Hi! ttj^irci an* for tho otfectn of expomiTC to lUrect hrat. 

Krikokk iuvcAti»at«d in huw much thuloMof heat by radiation was rotArdod irheu 
•Rireral layers of the Niroe faliric wore drawn tijfhtly ooe over auothor^ aud he noticud 
is deable layers a rudiadon of^ 



:t $ tn thin silk. 

4 { iD (pitta-pereha. 

^ f in DhirtiuK or fine Uneu, 

6 S in thick ttilk, 



9 $ in thick Unen, 
10~1S % in chamois, 

14 )C in Sannel. 
lA-126 % ill winter kid leather- 



To other words, if 100 beat-uuiwi |»iMod out In a given Lime through a i<iDflc layer of 
cilk. only 07 he:»t-uuits encaiied throuifli a douUe layer (tii;ht]y drawnj of the name 
materinl, These fnirpriNin^rly nmall (liffi«reni«R are an t'videnoe nf tlie retonlatiou uf 
the li»» of beat by friction in the railiation through the second layer of cloth, whose 
port-* arr: prcclnely similar to ihow of the alrejidy thorouRhly heated pores of the 
fiiKt L-lr>th. mul funu iu n-ality only the contiiiunlioii of th<^M> ifuren. In other re- 
•pccta the dilfereiicea Uitween fabrics are not c" nmch dependent upon »rcight and 
Bolidlty aa niwn their fhape aud volume, If. hctwerer. KKtKUKii drew iinly the fir»l 
layer of clocik tightly around hin tin cylinder, and altoweil the itecoud to hnni; at a 
diAtaucc uf fruiu .5 to 1 cent, fruiu it, Kutucwhat after the fa^thiou in which we wear 
our external clothing, he noticed a much moi-u marked dimiiiutiou of the loss of 
heat, to wit : for linen, an inrreano of ;t2 ■; ; for »hir)iug», Hii J ; for nilk, li'i 1 ; for 
flann>*I, £l^ V ; for chamois. :10 *, ; for (jntta-percha cloth. .% i. Thenc** followa the 
v*rj' iiijpdrlnnt |ir'i<i>of:itioii, that wo may be mucJi more or much leu* warmly clad 
iiirlth ill'/ ;<iitiii- jtTH.-iiiit of clothiutf. necoidinj,'B*i we wear it tijfht or loiwe. Tho eauio 
' ' of Ihii •iiII>'n-uo>- if '.he thiuknem of hented layer of air luclosed between the clothei. 

It U not aUiud tlte Ktratnm of air inclosed betweeD the flkiu and the 
dotben n'liicli |.ihi)K all iiiijiortunt j)iu-t. in jireventing hvia of heat, but the 
tir iuctudeil iii the fabric itself — tlie aii* (.entering uitu itn texture. 

PRTTKVROFRR bart invofiUfrateil tho c|ueatioD of the pennenbUi^ of rarjoua fabriof 
by mean* of gla«« tut>e-,x, one eml of which wjw cloimd hy piuccH of the doth to bo 
tened. wfiile he forced air through them. Thn.uigh pieces of nimilar areas, in Himi- 
lar time*, the air pAued in the following relative amounts, fhuinel beinj; ootisidered 



clotHiso and BEDDrsn. 

as 100 : tbrongli !inen of mbdinni tbitikiiMi*. M ; llimtigli riIIc fabrics, 10 : ohamoiii, 
ttS ; Canned white leather, 1 : Miininn lenUier, '*>!. Tbe protecting- (effect of olotbiuK 
does not t^illicr dejieuil uiiou thv ili.vree to whicb \t- kect>* ^c ait off frutu lu, otbut- 
vriac kid f^IoTCii nouUl be 100 timen warmer tbati tlanncl, whicb, u ix well known, 
U cut tbu ciiMt:. Othnr fnbnrs containing mucli air ar*', ok wftll an HannttK well »}• 
ai)t«td to kotip n« warm ; a« for example, fnrwh cotton- wad iling (in oontradisttiiclton 
bo tbiit whicli i<4 old and (wiii|)rc(>M^l). and fur, with it£ delicate bafn (o wbieh tho 
air cltc(;n. KkiK<^;lk ebnved fur. and fouLd that ita power uf giving ofT hcul was in- 
crc&nc'd in tbe [iroporti<ui of 100 : 100. Tb^ drj' Hkinof sbaven £ur u, bowever, alwaj'a 
a little iMiruua ; if tt Im c^frviirud with llofieud-otl varniah its [mwer of transmitting heat 
rij>eA ta '2'iH. Olid hy niL^iutii of a coitting* of g^um-arabic it rcncb»K 2110. ShaveD and 
variijfihnd fitr-hfnrinfT animal!! dip thronpb refrignratinn (the fToexing-rlenihi. if no 
heut be iriveti thorn from without. The more dnlicnte the hair of the fur, the 
more warmly it eovi>r». becannc thu heat leaving tho bodj' in so mncb bettor rftniii«l 
by it. In a gi*i<*l fur ruiimui, buwuvur. Ibt- body-heat is nut i^rreattT iu muuiuut than 
in H'int«r, In the winter tb« eqailibrinm betwcoo the temperature of the i>kin and 
that of tbe air ii* foiiud near tbe root of the haira : in aammer it tAkes plac*^ near Ibeir 
free ci»K lnj|n:ruit;a1)le fubrion do not |K>«seM tfaeso good quntilies of fur. and axe 
oou»cqut:iiU.v u«cd us clntbiujc only for Bpoctnl objects. They allow of tin* pitnctra- 
ti<^in of u» dainituetu from without, but cause the retention of the (ItudH of rvafH'ra- 
tinn, and ribtrict thn circnlAtion of air in the nnderljHng clothrn. Water-proof coat« 
arc good only to shield us from the wet; tboy make us moint by tho retention <tt 
pcrspirotiou; tUey arc u»oful only in wot weather or lu great winds, not iu wet and 
wanu ircnthwr. or in a calm atmoKphcro. 

The mrtre tlie air of a tis!>ue is (lisplaoorl by water, the li** it crtn keep 
lis wann, U'cause it becoruus a much bett^^r conductor of UeaU llenco (he 
Qusi' witli which wo " catch cold " in wet clothing ; hence the 8nsce|ttibility 
to dninpiH'Hs. If we gu out into a culd and dry opim air, we do tiot^jfttrt 
pasifn, fei-1 fls cold as in equally cold but damper air. 

We must not undervalue the hnportancc of this. Pettenkofeb cboae two equal 
pieceK iif liucn ami tluuuel. a^ repn-tieututtvefl of tbe in08t important animal and ve^- 
tahle fnbritai, dri'^d them at 100'' C. at which [Kiint they lose nearly all their bygrw 
w^npic water, and wt-ighnd tbt-m in actnirattly-t-loeing tin boxen of known weigfav 
They were tbrn exposed to nir nt variona degrpca of t«^m|wraUiT«, from lime to time 
rpplaof'd in tbe tin boxes, and weighed with oil necoMary prpcantinnn. In thi» W07 
the v«rijiiiijnft in weight— in other wordH, tho amount of water taken np liyi,T<iScopic- 
idly hy linf-n and wixil — were eaiiily njtcertained. For example, lu twelvt: bonni tb« 
following t|uautitiu8 of water weiu taken up by t,UOO j^rauunas of tbu fulluwinCT 
fabrics: 

LInea. Iff'tnl. 

At r. 2 0. in lectar© room T4grm. 14.1grm. 

** 3\ I C. in collar. 77 " 157 " 

" 4'. 4C. inwllar Ill " ITS " 

*'13'. aC in lahf.niUiry (W " 10r> " 

" 19". C. in roum 41 " 75 ■ 

^Jf we cstinmte the weight of a woollen «ult of clothes at lfHb«., tin- amount of br- 
IjlOittipic water containr-d in it, oons«)queiitly, la H 'b,, which qnanlity will reqiire 
for it« evaporation 4*3(1. IHtO heat-uniU. 

Uniler all circiimi<itnncc8 wool containft more bygrnaoople water than Unen, and re* 
tains it also much better. ConxeijnRnMy the nliangea in tbe amount of wat«r oon- 
taincd in linen are nvore rrtpi-l thin tlinw in wiml during the evaporalion of water 
in drj'. oud the acqui-Hitiou of water in wet weather. 

Both auhfllance« exhibit t-imiUr r^^lntivo proi^erticii during wetting by. or the dry- 
ing of tbiid wiiter, I,iii«n in e-A»ily f«itur-.itpd with water, and wnier ewmjira from it 
(luickty ; wool lo»f« water slowly, hnt it takiM up uineh more than linen. Wnt<*r evap- 
orate* more rapidly from a lintn than from a woollen (mrfacp. which bitu>r ytfliin up 
itn wnt<>r in a regular way. tut in shown by tbe following taiile. 1. 000 ^-rominep of 
linen "waked in water, tlirn preiwed untC no more water could be forcol out of it, 
ret4UUc<l 740 grammes of water ; and 1,0(KI gnunmi*M of flauuel treated in the mudo 
way retained Ol<( gramineB. Tlie surfaces of tbeae equal pieeei of tiaaue wore like- 



ri 



< 





CLOTHING ASn DCDDIXG. 



79 



viae equal. Both olotliA were hung' up to dr7 in a heated chamber, and &a WBt«r 
retailed in thum — 

I.lnnn. TIUkML 

After 15 nun. In t«nip, of SO" C. aniouated to >)2l ^rm. 701 ^m. 

" « '* " 20" C. '• ftSO •• BCKJ •' 

" 75 " " lOOO. " 221) " 457 " 

'■ IW '■ " 10° C. ** 110 " 800 *' 

" 183 '* " III" 0. '* GO *' 104 " 

It in easy to undofstond that fubricH nA a wholo, bv the pni-tiat stoppage 
of tiieir [HJi'Ub by wntor, lose thr-ir |K;rnieiibilily to air wbi-n lht*v bwronie 
wet. (Jonrsti tissues with Inrgf. port's teiimin loiigtT jHsn'ioiiR lo ail* ; with 
Bul>atiuic«R uf MiiiiUr pmosily, tlie aiUn-Kion ul' water to the fiibiio dfter- 
niiiipii wlnth<!r it ttiiall cU»s«> iLs ikip-m hIdwIv or t|uickly, temporarily or for 
a long time. TinoD, i-otton, aiiit silk are quickly hi>niit>lirul1y nealetl by 
WL'ttiijp; while wool does not lM>conic so, or only all4'r satui-ation. As the 
porosity of all ti&suea dtipemU mainly upou tho eliiatiuity of their (ibrra, it is 
of the hight^st iiupurtutict^ n'helhi*r it be th» Kanio in the* ilntup and dry 
tttat4-a, or how uiiich it may vary ututtT iiiumi conditions. A character 
whii'b dUtingnJHhMK wool ftifin the other thii*e sutmtaiicvs, is tliar its tibi-es 
retain alniiMt all their ulruticity when «"«)(, wh&i*(>«A other fibres lose thuin; 
almost wtioLly. It in IX'Ouii^e Uu' air is niore driven out of linen or t^ilk 
fabrics Ihau out of woolleu oncm, that we catch col<l more easily by beitig wet 
whiltf clothed in linen or flilk. Similarly wet woulU>n fltoekitigM do not ]»ro- 
dnct cobl feet aa easily aa wet linen ones. On the other hand thiii peculiar- 
ily of silk aiul linen is of advantagn when it is <lt>KirabIe U* keep the iNwly 
warm ami drj'. By oioaus of liiiHu ubii-ts we ellit;ietit|y i-cmovi' ht.'at a<i»l a 
moderate atuonnt of eviipni-ation ftoin the skiu ; whilu profuse perspiratiou 
is bi?st iftken up by a woollen tissue. 

A %'cry important article of clothing (aince in it wo pnae a grrat part d{ 
our lives) ik the BChniNG. The bed is not merely a pliure of iv.tt, but also 
a cover during sleep. Bedding ia nuule of the same materiiils as day- 
clothes ; thfi.V! usctl next the skin, of linoUf silk, and cotton ; tlic underlying 
p«rt.s, of animal librca, fenthcns, wool. The bedding must be at the same 
time warm and airy: wc heat the bed with our l>ody just as we do onr 
clothes, and in its turn the Iwdding heaU the nir which traverses it front 
below upward. Tim Inyors whieli n'^idate the lirat are thu-ker than thnae of 
orduuiry clothing ; this is re<iifired, becausf in the ubsnluto rost of sleep tis- 
sue meluuiorphusis is unich reduced, and leas heut is pitKluced : nmreover 
the air is mure thoroughly lieatt'd in !iorizi>nt«I layers thari in the ei-ei-t po- 
sition of the Iwdv. Tlio Ikh) is a most iui[>{trtant apparatus for the ]>n'ser- 
fcirntinn of body-heat; siiiee the heat of the l»e<l keiT]w up the oireubititm of 
eripheral parts without groat waste of tit^sue, thus relieving t)ie internal 
urgnns, wliieh are thus enabled to ix'st. Whoever, for several days in »uo- 

sion, cAunot lie in bed, ilues not feel rested, but uflen al»o experi- 
etie^^ changes in hia teiiijM»rature. Beds are, panicularly in cold weather, 
indLS]>ensable i-o well-being ; they, in a certain degree, take the place of fuud. 
Light bed-CDvering is advisable for young people, because much heat ia apt 
to iaL*renHo the sexual apjs^tite and lead to onanism. 

Ubder certJiin circum.stances eloihing may be also useful for the purpose 
of shielding tiie body from heiit-rays ; as, for instance, hats iu summer. 
Tlic mo<ie of its operntion in such aisea is just the same as has been de- 
scribed above. 

Weight is an nlement to be oonsidored in clothing, because heavy ai-ticles, 
if tliey btt bad coudaoton, overheat the body by the exertion uccossoiy to 



80 



FOOrt AMI nniJCK. 



bear them. Tlie samft elpnient should h*^ kept in viev iu the matter of bM- 
covt'riiig; it xlinuM not. Uc ^<) thick anil heavy as to int4>rfi>ro with tho 1*6- 
spiratory inoveini'Dt«, or uniiHturally iuci'ifmiii jitTspinition. 

*' Our clothes are the veiiiKiiis with which nuin conibatH tb« atmosphere, 
in BO far n^ it is dangi'mtix/ 

Artichts of clotliing may prera upon and injure the organn over which 
they are placed, lu womtiu there »m often found transverse tleprnssiuua 
in tho liver with oj>acity of its capsule, and atrophy of its ti-ssue, pro- 
duced by corset^ and )»<ttiooHt liandft. Moi'mror, exoetudve lacing prudnctta 
di8pro|M>rtionat«' hii^Hthing with the npper thorax. The preasnru of bhoes 
produces various diseaAes of the soft parta and bonea. 

Compare PETTESKOFRn. Z«it*tJtr. f. Biotrtffu., 18*5, 1., p. 180, and Baifhunffen 
d^ Lvft *« KUwiung, etc, lW7a. 



I 



G. FOOD AK1> DlUinC. 

leaving out medicines luid poisons, tho consderation of which belong 
to pliHrriiHi-4>lu;;y and toxicology^ we can divide ingesta into nutritivo nod 
pleasing nniteriatla. 

Only such substances can serve as nutritive materiiils whoso ctinstitntion 
ia Bimilar to that of the tissues of the body, or, at any rate, such afi contAin 
the elements npede<i hy the tissues, such as nitrogen, eartton, liydrtigen, oxy- 
gen, sulpliur, phuKplitirittt, iron, chalk, potaMta, soda, etc. It i« widt known 
Unit till' animal orgHuiiation docs not form the majority of its proximate 
principles, such as alhtmieu and related bodies, fat and sugar, out uf the 
elementary Ixxlics, hut that the substances must be exhibited iu aa organic 
or complex form, iixnw which they are cliniinatiMl. 

Food may be noxious because too little or too much of it ifl ingested ; 
and, besides tiie form and nituui, the temperature and quality, the uniform- 
ity (with Inspect to the pi-opurtions uf aiiimiil and vegetable ingredients) 
of tlie food, aa well as, lastly, the irregularity in the time of eating, are 
injurious. 

For the condition of absolute fa-sting, as well as for the effeuta nf with- 
holding im[)Oi't4tnt iLrticles of diet, see paragraph on the anieiuia of inanition. 

The iivils bi-onglit about by the shape and amount of ingeHi4i, of solida 
OS well fui Hnids, belong to spnciid jMithology, hccansf! the lesions and dis- 
turU^nrcK product*d are local. 

Th»' tvniperaiure of food and drink is a cause of disease only in tliat it 
may lead U^ rL'frigeration of tho stomach, and with resjieet to the p>tssible 
evil oti'eetR of cold dnitks. j^loro rai-ely, in childhood partieul;irly, we 
meet uith burning of the upper ynvt of the digestive tube, and C0tut6(|uent 
infltimnmiion of tlies-* purts, and of the npjt'T air jMWsagCA. 

Thci tpmllLy und til elfeets of food belong more properly in treatises on 
diseaAes of the digestive oi-^ians. Tlie general ooiisei|uonce5 of spoiled fooj 
i-escmblc those which follow uj)on the use of too little fiKjd, Water which 
claitnH to bo "beulthy pure drinking-water'' must not be chemically pure; 
it, should, on the coutrai-y, contain certain ingredients, and only a minute 
quantity of other substances in order to Ite harmless. At any rate, it must 
lie clejir. A water which contains visible impurities is not to be ivgarded 
as good drinking- water. Kveu al\er tiltratiun water may be dungeious to 
diiuk, because some of tlie injurious ingredicnta may remain in solution. 
This is the roitaou why filtered river water which is furuiahed by tho watoiv 




FOOD ANn nitl.VK. 



SI 



works of niaay towns L* not liealtliv, or not al all so comjmrcd wilh clcur, 
frt'sli spiiiii^ wuior, wliicli should aluuo bo used for this pur|)OK^. Tlit 
}deuHiiit Uat« of tlie latter is |>rwluc«d by tlie presence cliielly of CO,. It 
uuutaiit!!! salu, as foUiiwH: cbifHy chloride of suiliuni, Btiiphat« aiid L-arlx>ii- 
ate of lime in small qiutntitii», so that the result of dcsaiciitian of 10(1,000 
j>art>t of welter never exceeds .*>0 jHii-t*, or (1.0005. If tiie HiimTal ingi-odi- 
nta exM'cd 0.4 jt. c, or 0.001. t.)m Ii<|uirt ik railed MtM'inAL ivatek. 
Tlie most itn|H>rtjuit iiii[»iiritie8 of diinking-wat^r, pHi-tiouIarly m thai 
^turn from puiujf-n'idls in [H^pultruK dintrictH, arn iiittatt-M, t'^prt-ially iu 
oomlmiuliun with auiuionia; abundant cliloriiio ctintT>inn.tionK, and^ Instly, 
organic Hubittanct-K of nniinal or vegeiubtc nature. Such impure water^ iu 
order tu be HtlU drinkable, must nut cont-ain in lOO/'OU partd mure tkivu 
0.4 parts of nitric acid, 0.8 partA of chlorine, ami 5.0 parts uf orgnnio mat- 
ter, lloiling does not much improve such wator. Theao impurities itach 
the drink tug- water maiuly through sewage water, wliich filtei-K down to the 
iprella. They prr«diic« prinrijially gatttric and intestinal diseaseK, and proba- 
bly also flounitiitt'is ty]>lioid fever. 

That the above nomad imporiticii may, nnder oeitain ctrcamstoncea, tet np infeo- 
tioaN di!tttaM«, particnlnrly ty|ihnid fcvt-r. is proven by quite a Diimbnr of old aud 
z«oenC rtt»ior\-tttKinH ; aitlionph thw in dpuied at the present tiny by competent ob- 
(^r^*rt tOimjiur*^, oil th(' first, aitic. <if the ipicntioii. Biermkr. I'ftirr EnjilfJtuny und 
i .' itfs Afxlamiimlt^phiijf. m V<il.KiilA?lN's IdinUeh^ Vortniij^, 1^7^, No. HH; 

fi-i lier wde. I'rhrr tiif ^EtUif^rjif >lt'^ 7'tfji/niJi, Vortn'isf ivit Btll)., FlUKD- 

Ki.lCiI, ¥. GlKTL. K. I'KTTKNKOKI'.M. etc 1H72.J 

.\t miT nte, it »-ill Iw admitted, that to pruvide pure drinking- wftter is one of the 
iij I ' taut pi inuiiileH uf hy^ii-nc ; Iii;n«! the niimbur of pnijcctd for i^fltaliUahing 

■>■ f.i> C'lii Inrt Bpring wat«T into Inrgp citiea. Wht'thor a wot«;r w puru in to 

I- '■! .iiiH- *)T rhfrnical menrnt ; particulnrlj* thi) taste is an nnreliable te«t, 

^11' ■ '■ >:-■:■ u^ tof> mu*rh saline matter, and conseqnently unfit fnr use, muy 
t^[i' .' t.\ ,' ' :< ■• >: ; In di'iiiif tliis it iii by nn means uooossar^' to make au exact 
■e»tmi*te uf each element ol the rwrifbie of the water. 

K^DLKoKEn {Z'ifjtrjtr. J, JJu4. lHtl5, I., p. '^1) has made a thorough examination of 
the oi^nic sabBtanoee preoeal in the wcUh of Munich. 

Under the name of del!r;Acie8 we scparnto from the foods a clafls of 8ub- 
■tuuo.'K whose ingestion is not nocensary to tlio reconRtructiou of the tiN*mos, 
whieb are not theuiselvea present in the body, but which must satihfy a 
derp nt-ed of human nature, b«K.-au8P they are almost universally used. To 
ihis claKM brloDg alcoholic drinks, coflW*, te», betel, toh«(vn, coea, etc. 
Kven the mnnt primitive raoea employ one or other of these subsiann^H, of 
which it can only be Boid ihat they soinnlimes excite, aomctimeH ih-press the 
nervous BV^Uun, and somewhat retard tiattuo metamurplious; and aliio that, 
under certain drauuiHtancofl, their uhc nmy cauxc uririouA dtwasc of the 
nervoua Kystvni, and btor, of other nysteius. A oonsidei-atioik of these 
Bubstanci^s individually is here out of place, 

[Commit: pAnKB*. Afi$nttiilo/ Pmrtifiiil fri/i^rne^ltond., 1864; JlKlcrt, fii/nlrtn rhr 
Jhgitne. 1870-1 ; nAUMoNu, A Treatue on Myguiu^ Thila., 1803; rEuiiiBA, On 
Food and Ditt, 1843,— Ed.J 



7- 0CCI7PATI0K, I^OrESSIOK, AND OTUBK SOCIAL CONDITIONS, 

It LI not in the provuice of pure ©tiology to determine tho importance of 
the fintt cumlitton, for the result to which the occupation leads depends 
largely on the degree of auece«s attained, and a niimU^r of delicate pcraoiui 
are never called to any bttKiiiu&s. 



OCCTPA-KOW. 

Thn qijPHtion comnH np for considenitinn from grnoral |K>ii)t8 of view. 
Poisons, in the form of pciwtier or VHpors, which somotiinea act only in a mt>- 
rhnnical manner (aa in millers, watcU makers, stoiie'CUtters, grLndoMs), soiue- 
Umos clutiiiioatly ([Kiwdnr of poisonous metalu in foundrj- wurkmen, leiul-pov- 
dor in ty[>e-ii)ouKtert4 and buusc- pain ten*, — anioDtf gujiiuen) : con i pa re p. C 4. 
By loo great or too restiicted movemeiitB of tlie body, with conKr<|utiit 
eflpcU «|K>u the luuacleK, Jwnes, respiratory aud ciroulatoi^- nppanitus; the 
long niaiutenaiiCK of cerUiin attitiideg, as sUndinja; in con i|k)hi tors, which leads 
to varicose veina ; as the bending foiward of th^ tham\ and the prrvention i 
of roni}dete lung expansion, in shoemakerR, tailoi-s, and weavers, IcadiDg to 
congtwtion of the lnnjj[ttpic**H, pixKlncin^tnlvercnlosiaoreiujihyByma ; contiue* 
roent to a room, in aruall, Iwully vrntiluUjil, and uvyr-crowded niiinufactoriea, 
Bud other work-rooms ; or i-omaining in the open air without sufficient pro- , 
teetiou against tomiK.'raturc and dampness ; or e, ivoi\Mciit L'haiigc of place 
wliiU* in a lieat«d Ktate, by which workmen are made peculiarly lia}d<< to | 
pulmonary disoases ; over-esHi*eise of tlit* muscles, prtwiuciiig alrophy of j 
these oi'gana and other conaequpnces ; Btraining of the i-espiratory organa, 
aa in jierfomiiMS uiKHi wind inHtninients, criers, clei^ynicn, tt-achwa, eon- 
liiieing to pharyngitis, laryngitiH,pulnionary eniphyM^ma, etc. In ndditioa wc , 
niufct recogniro a ntiniber of more or less ancideutul influences inci<U-nt4il 
thii oecnpation, as in tht? caao with inn-keepers, brewers, winc-merchaut 
fisburmen, drivere, commercial ti-avcllei's^ and iM^xMially soldiers. 

Tb« mortality in Etiropean arroira in time of peace ranges from l.S to 2 per oeot. i 
wheraait in the males of the same agea in the civilian popnlation it in onljr 0.8 to l.S 
per oent 

Intellectual callings areas a rule lienlthy, especially if the mental labor 
c»Ji be pursued in a degree of comfort : clergymen, professora, mercbanta, 
lawyers, live to a very old age, Other )iU«llcctnaJ o<:ciiin»tions which 
iieci'-ssitHto emntioiial i>xcit-emr*nt and a free, if not quiti> regular lifci, more 
quickly wea-r out the tndi%'idunl ; as in the case of j^oliticians, artists, 
actors. On the other hand, phtlosupbors and mathematicians, who are 
often ill-nnnrialieil, reach on the averagi? advanceil ag"!. Teat-hera and phy- 
aiciana, as shown by statistics, die earlier than others who are ]>ut in tba 
cla5s of intellectual workers. The most furtunatti are those whose occufto- 
tions oblitfo tliem to take a good deid of exercise, as fiirmers, officers in 
tinieH of peace, waggoners, woodmen. 

The mortality of the Tarioos prafeasiona is muob better undentond than tbetti 
moriiiUty. Oahpkk, Withrfclinntichf Lrbetn*l<iuer. IH.'J.'i. LouniRD. Ve Cinflvftim 
de» proj\»»ionM 4ur ht duric de lit tiv^ lb3l>. Necpviixk, JjeAff/wfAi'jrr «nrf TotUtur- 
Mcnen, u. s. w., 18&9. 

Civilization Ims been aceuRed of having hronght along with it an increase 
in morbtlity, and in the number of diseases. This may be; and yet, with 
ini]irovcd culture and an increased number of phyaicians, mortality has 
not increased. 



Iq Oeoen. aooording to the eatimatcs of Odirr and M.m.i.kt, the probable dnra- 
limi of hfi* of thn newly-hom. wan Uvu years in the Ifith eciitury. twelve ytjam in the 
ITcli wnttiry ; from ITIU wi ITdft, twenty-seven yeant; fmiii ITfil to IWIO. thirty- 
two years ; from ISOl to I8i:(. forty-one yearn ; fmrn ISl.'i to IH20. (orty-iivc yoar^ 
In tlie twentieth year of life tbe probable »nr\-ivai waa. iutlio I6th century, tvrviity-two 
Tears ; in this centnry, forty years. At the tbirbietb year it wati. iu the Itrth urutuir, 
ninotevn years, and thirty-two m the 19th ocntary. At the sixtieth year there is 



OCCUPATION AXn SOCIAL STATUS. 



83 



iDDiuTcd a mow cltial time of probable Bun'ivtil m nil otmtnrieH. Tn nne hnn- 
ui Years Ihi* pnihitl'lt' length of life of nflir-lHtrn cbildreu bn* lULTeiwed from (1 to 

I vrftj* ; in Bi'rlin. from i^i to OR ye.-irw. In Uf'rlin all ages nbow tlio impravud 
Tiabititir. The mnrltod improvflment ohserred linrlnj* tluR cvntiirj*, iliijtviirii* pn'iici- 
pkll; upon The lx^tt«;r citre of yotiii;; oliildroii luid the iutruductiou of Tanuustion. 
The IcBMA b>- wnr. thuugh iitTecLiug the strongest iudividualy, are Hubordinnte; gt«u 
wnmrn fw>w live to U ffTLTtUT Ui^. 

t<i -tthf r iinlhoritU*!* the ttbrtv« rwalts dopt-nd upon errtirfl. beoaUiMT tUc 
oii H-pfp miiil<> chirlly in a few large ritien. If the ccneml mortiility hiu* 

diiitJi-ii' '. in SftT'lcn, Frnnce, and othor oonntries, dnrinjf the lawt oue hundred 
ypor*. ftiid ;hf* iiicm;,'f of Utrr iiiiTc-awd frtun two to wveu jean*, it it* in coiiKi*iju«*nce 
oDiy of a (timimitiim in the birthM and iu iufHi;t mortality. In ['niuia tht- nvernjjc 
kfl^h of life hn« not chnnywl *ini* IHUl, and in England not in ony buudriHl year?. 
Kv«n if th»! (liimtiou uf Hfp has «>m(^wliat infrrnawd, we muKt not conohide tbai the 
actna) gnfitrr vitality and vljjor of nations is proven, or even miule probnble. At 
Mar rate, iiifaiit mortntfty alout- baw tlcercaBiid. WcU-tti-do p<-op!e live inndi longw 
thuix the poor. 

Aci'onliuK lo CAitrKii, ont of 1.000 poor in Berlin, (inn-ihird iliol in the first five 
j«3u« of lifL-, wIktwo*. ont uf l.WX) woll to-do perMinB, oue- third had not dieJ at the 
fortii^h vr^r. Ou« liAlf of the poor gurvivc the ugc of thirty years, and one bnU of 
the rich that of Hfly. 

In hlof-Iiod the Peers are cxtrrtorrliMarily favored ; the gentry (nohilily in general), 
stnn'l, in m-pcct to loii^vit/, fur aljove niur^thanl/t. and tlie morobanU altove the 
»■'■ I'le. Among the laltrr the atrricnlturnl lalHireni are Iwtt^'r i'lrt(N>d than 

III' virkmen. In ^i<T\i.-ra\. the iiitluonee of comfort and aJH'ieueo upon the 

pr. I <)f life, if< mast niarkM in infancy anil ic old age. NntnruUy, thin gttn> 

tt t\ n-Hult d'^s not exclude the ticeuitioual survival of iiidixidaahi of the 

1(1" - to an »'xtrenu'ly noiuiual old agB. 

I'Mioity. we tnke ndnlt iMtrKOia of the poorer olasMfi to be from Btb (O ten jean 
elder than they really are. 

T^ostlr, it hM lu'vii likewif^e KtAtisticnlly demonstrated, that niBrruijjr — 
vithoitt nt'^iini to early or bite u)HrriBg(-' — has au extnionlinarily favor- 
b1>Ii» mdiience uj»on the dumtioii of life, Tlio regular life wliich tlic iiiar- 
rie<i stAtc carnes with it, together witli llie l>et|i;r Piu-e of the itulividnal 
rtiiritig ilhicvt, uro fiivumbie tu longevity. This is iipimrt-at in botli iiexi^H, 
but mort' no in the male sex. The cliiferenre of probahli* tturvivnl in tliw 
marrieil over the uuiiiiu'rie<1, and e»j>cciHlly tlic widowed^ U <|iiite im- 
porUmt. 

.ArcoMin? to Oaspkk a married man has the prrMpect of becoming sixty yettn 
ohl, whiln a bftohelor mnst be content with fotty-five years of life. WhcreuM, ouo 
qniiTt'pr of tnarried niun reach the age of icvcnty yaart. only one -twentieth of 
■ingle meQ attain tt. In thix eouuuution we Hhmild rHtutiraher, however, that very 
many m*-n die'between the nge« of tft-ftnly and thirty year* ; that on the whole few 
men marry heforn thirty, and that cnnHeqnpnUy the miniher of miim>d men dying 
between tw»Ttity and thirty tniwt be ri'lntively very dmall. Among the insane and 
■oicides. fntui two thitdrt to thiL-cfonrthFi arc unmarried. Similar r^AulLa hiive been 
reiu:hed by DKrJkKciurx, Odikh. and othem. 



8. fARASITES. 

SwAMMF.RpAJiM. Tlihel lUf Xutitr. feherg.j 17it2. — Van T>or.VKRE%% Abh. 
r, </. iri/r/«^i-7i itn men«rfd. JiOrper. f^ebere., 1776.^ — <3c»j!B, I rr#. einer 
y^ittnrtjeAch.iirr Kiuf/rwri'Un.ihitr, KOrprr, 1782. — ZEi>ER,.lrt/ffiV. zxtf y*\t- 
MTff^ch. ifey A'ittf/'-inr^if^iiu'irmjtr^ ISOS. — HrnnLPHt, ^nliizoonint hStit.. tmt. 

S*llOxi.Eiv, yfiOl. Arch.^ lK3i). ji. 83. — Stkeshtri'p, UeUr >i. Grnfrntiom- 
W^rhittl. \M1. — .SiRlioi.D, Arrh.f. XntnrfffMi'h., 1^3."), I., p. .50 ; Art. Pnra9- 
itm itt K. \Vaoxku*8 JfdiC^rterh. J. Phtjeivl., II., \>. (14(1, 1844. — PuJABDix, 



84 



PARASITES. 



ITust. Jiaiiir. (Its ]t^minU>fM.^ 18-15.— VooEi, AlUj. ymfh. AnaL^ 1R15, p. 3S5. 
— BRKTiioLn, Gi'ftL Xacftr,, IP40, No. 13. — v. BtsKPrN, /^^ ivm /-/v/oiv/m j 
ou acoti/Us^ I8r>0. — OiKKiMi, ,S>/»tfma /if-fiiiintfuun, ISriO-Sl . — Robix, //irt. 
ittUur. df9 VfQ<!tan,x pamititrs, 18.'J3. witb Atlns. — Wepl, Ortttt'is. iJ.paiJi^l 
//uftoL, 1853. — Kl'i IlKNMElsTKK, I*ir in uml an Jt^tn Korjjer </*•* hhi-Hden\ 
MenttcJitit rnrhimmentif^n Purttnitfiii^ 1S5.'>. — VtRdinw, Arcfi,, 18.'^6, IX.^ p. 
oft7.^<jEiiv.\t8 Anil v.^N IlENKriKN, Zofdoffi" iMiJi'^U^ 1S5().— Davaisi, I 
Tfaiti (Jes rnUtzoaifes ti tff/t malnflirg cfnmnfuacs^ 1800. — Fas^truk, .-Inn. i 
th ekim. et th phyt.^ IKC.O. P. LXI V.» p. 1 ; Ann, ilex kc. nut, zonl., 1861.1 
T>. XVI.— HARESsrmis.i, vlmi. d. Char., |.S(>2, X. I H., p. 37.— R.J 
LErtKAUT, Die mt^iiechl. J'arag. u. ftie von. ihiirn hi^rrOhr. ICruiJdt,^ I., IS<J2,I 
u. 18C3. 11., 1 Lief., 1S67 ; 2 Lief., 18ti8.— Kubner, Klin, u. (w/wr. .Vi(/A.| 
auD. A. JJrrnn(t.^ 1804.— Halliek, t/en. ZUtcfir., 1805, p. 231. I^ir pjti/nsLi 
J^amx., iHOfi, — M'Call Asi>Kllsi>\, On thr I^trnti. Afffrt.of' the Sk-iu, 2 tsU.] 
]8i;8. — Kakstcs, Chrmismui Jt PjiaiizctueUe^ l^OH. — Xei'manx. Lehrh. ilA 
Jlaviki-ankh,, llH70.^Kll>AM, JJer (fet/fnw. •StanJjnitikt d. Jfi/mht^i^^ 1P71. 
— ZL'rn, />w ihUr. Ptiraa. aiij' u. in d-. JCuiy>er muH^rnt ITnuAmrtgrifkirrtti 
187i.— CoilK, JieUr. s. Uiol.d, Pjlanzeiu, 2 H., I»7a, p. 127.— STKirDENM,] 
Volkm. Idin, Vurtr., 1872, No. 38. 

Parasites are nniiiml or vegetable organisms wliicli speutl their who! 
life, or certain periods of it, or live only tem[>orai-ily u^ton or within anotiicf 
living orgrtiiifini, for their nourishment or <lt>vclopinoiit. 

PtiKt,Di>-PAKAiiiTK8 are those paraKitfs which i>nly casnally happua npoo 
man, l)«oitus<^ they hon> liml ninJHtttnj, wnrmtJi, and organic Bubatnnoes in 
tleeonij>i'Kiitioti (many fuuj^i and iiifu.Honn). 

Of many orgntmnis iii it qaeslionable whether thej are parasitea or paeado-paza- 
A. VEOKTAIILE PAKA8ITES. — PII \'TOP AHA8ITE8. 

The vegetable pnra»it^Fi oeeui-rinp in the human body belong to the citjJ 
togumH, and to the fuTigi nud bchiKi'jinycctos, A numlter furuitrrly clftssud f 
BUii>ng the ntgu', aro now knnuu tis lower developtnent-forms uf fiiugi. Ex-] 
oeptionnlly perhaps, tlio »Lrc'iiia is an alga. 

t^HViTooAMR arn thiMwi jilanls which witliout prcotxHug visible blosttoml 
and fruit propiigate by luwuia of simple cells, or coll groups (stpori's, germ* 
gninulttK), and which dovelup iuiuieiiinlely, or in f*->rin of a sprout, into «| 
new individual, Tlio-so cryptogHULs whiuh inti:'rest us are (in oppota-j 
tion to the vascular and liytf-fonning cryptogiinis) the so-called coll or froud- 
plaBtB — the thrdlophytes ; tbo frond or thallus ropiT'Sitnts in Ihu orgaulaitiun I 
luut, steo), and leaf. 

A a. Ftiroi. 

In the cl»J*H of fungi bcloiig tliosc frond plnnto which have no chfiw^ 
phyll in their celU, and recpivo their nonii-shinent only from previously 
organized niattoi', and are thorcfore inca|table of forming all of t-hc^r 
orgaivic ingi-edient^ out of inorganic matter ; which take oxygm from tliR 
air, ftiul iu rplum Kftcretfi cHrbiuitc aeid. With n*Kpt'rt to the seooiid trait, 
tbew !iix' diKtingui.shed : true jmniaitic fungi, which draw iheir uourinhmeiit 
from the Wuid.s of living organwins; iind those which live oiily ou dcMMyiiig| 
Bubstnticcs (KaprophyUtK, oarrittn-fuugi). 

The wholo vegutative body of fungi, Iho THALtns, conaiau (» f«w doubt- 



* 



JUi 



VKGiriABLK PARASITES. 

fill cniu'H pj|pp|it«l) nf filiform, mom or U:km Inuriehi^d HteniPtilM, the fungus* 
filiuiieiit or liv|ibi!ti. Tbosii grow at the «xti-eniitie», juwl the t«niiimil 
cell is always the only ou-i to divide. ITiu two |ii-tnci|ial nieutHtrs of the 
thHiluB are: 1- A imrt ditTused within or ii^kui thi-' suhettnituni, to tjikc 
and Hturv u|i nuurihliincnt : th*^ root-phond, uy<xi.iliii or HiirxoFODiUH : 2. 
the lK"diw» sitrinititig: fium it, which tieur ihn |ii'Li|paguting oigiins; tho fruit- 
bvnixni ur KRUiT-riLAMKSTS {atiftitefi, jteJujictUi). 

Tlic MVcKMi'M piMiseHse* nt'ither in itstOf nor in its ItlameDts Hpecial 
{iccii1iantif.-«, h<> thnt it is ditfirnlt in- itiiiK»Ksihl<? to df^tciinine even apprux- 
imatividy, to which s|iedus of fungus a bU^nlc luvccliuui belongs. GKpe- 
cukllj IB this the cose with most |iiii'asitic fungi. The fruit- btai'Ciit suji{>ort 
tlitf organs uf ivproductton. The latlur r^'preni^at the lvIIs, which are the 
germs of new individuals (.ii'onEs, eto.), us well na th«? inother-cells fmin 
which they are gt-nerutt-d (aaci, i:U\). Tlio fruit-l>i;atx>ra oontiiiit eithrr of 
n. single fungus tUainent (KtiLiT-KiLAMCNT, fruit-hyphen), or they form u 

U{>ound fungiiH body (fniit-lHidy). 

riK> prnpM^ntiun of fuK!^ i» iit no case through B[K>ntaneonB g^neiutton, 
But takes phui* piirlly in an anexutil, partly in n Rexual loannor. The 
former only u of inlen**t to wa. Tlie fungas sporea are devclo|KHl in thixw 
wavH : b_v free e-^ll furiuuliun (the mother-cells are callwl aaci, theae, B|»ore- 
|>ouehes); hy eonKtriction (the molher-eellH ai-e I'^lled iMiKidlHiia) ; by a 
growth-like or vegftAtivi* process; cell-tission or geiuiuatiou (the mother' 
colls are calKxl s|Ktrangia). The mature spores are either movable 
(^t/vi/-r7*-»jt»'>frj, znoHi'iutKH), Of mntionU'tffl. Tlie fonner embrace jii''jpor- 
tiunately frw fungi : thny are nake<.l, pitiloplatiniii.' f<u'iii.H, without a ijitttiitct 
ccltu|r»»4' membrane, from whose surface two vibrating eilia, at the most, 
•firing forth. All of the remaining apori-s are uithout independent motion : 
th«*y have at the time of maturity, or even earlier, a permanent eell-nn^m- 
brann which cotisist)^ of an outer layer (epis{K)rium), and nf an inner layer 
(en<iaaporiutn}. — Most spore membranes are characteiupd by their great 
retastunco to decom|mHitiun and strong reagitnts, esjiecially concentrateil n4iu- 
end acids. Th« cnntenta of the s[n)res consist o( a masa of prutoplaum, 
houiog^ueoitu or containing lu variable ipmutily, gruuules, oil globules, 
and varuoltw^ and an- usually without a n^ndeuK. The sporea an; ho devel- 
o{M>(l that the membnine Hvst bursta, and the eontcnt-s protrude in the fonn 
ofa|M>tn'h; thia germ-p«uch elongates raoix* and more; receives a »heuth 
k1 bruuehex, and ibuM fornot the mycelium. It is in the froah al^te largely 

npoMHl of water; when dry, it actively imbibes moisture from the »nr- 
rouDding nietUum. 



SronR!< ahe t»k cuiEf iirvsR op thk «RK\TSPnE.vD of fitsoi. Tbclr small 
■iae and 1i;;liliii'w make H po»uaJliln fur thnn to R|m*ail cvurywhiire, nut niity iu 
Uqoidftt Imt nh^' tltroiiKh Ihi? air, The I'xaintnfttiDn of duKt, of |>artiulc>4 in the atmon- 
■bttre. of hnman and aoiinal nc- and excretions, uIao the fpecial czi>«riment« of 
Pastkvr, and others, bavo shown that fnrigaia spore« oapablo of dcvelu|)meut are 
Itraaent eTftrjwhcre. 

Tlie pritieijml ctiditions for the growth of fungi are : moderate wanntb 
(0-40*' C), moisture, some oxygen, stagnant ami aeldom reuewml air» ami 
orpinic aultatanco. Light is unnecessary. Many fungi grow only iu 
•pecitic liquid*. 

Th« cjttani''" "'"i' ■■■^■i---: Qf tlie noaruthnmnt ami inirToauding media, fxercixe 
^**t JnJIneri n and mnde of fmctilicnunn of fiuig'i. In t>n« mtHltam 

the ai)-c«Uo 1 1 ly. whllo in aiinther it diminishes to the finest filament ; 

irUh one food %hv fungui pnahea fortii vij^roufl opotea, with another it constriota the 




86 



TEABT TTWOr. 



rjKire pencil, with a third it dtridM iuto veast fungi. Upon this depcnflc the w»-nilW 
■pltyrtifrfthi'iin (Tui.AJ*Nt';i ; i>., the aamo pluutx o«n wicur uiulor two t>r more fonos. «& 
well with ri<A)>(.'cl ui ibc atyiuis of icgetation lut to cJionc of fruulUiofLtiuri. Alau Llie 
weather, amouut of traU-r. vtc, have au iDllueat-o upcm tbt- ixicrciLM!, otc., of fiingnfl. 
— ][ai.i.ikk tuut reuijuUyifiveii tii« th«t>r,rof TrUA^su an unjao iiii|K)rtanoe - Boxor- 
DKN rcjectfl it; DE Baiiv liSMumtig an intermediate piMiion. 

The |wtliologLe:illy iiii|K>rUiat fungi belung to the foUowiiig gi-uupu: 

Dt78T OR GERM-Frxnr, Conio- ok Gyuxoiivoetes. 

They consist of single, clustered, or loosely txinnecwd spores of one or more 
cells, which geiiniiiutu and <levt<lo)> into » tiliforiu mycclitim, out of which 
Hjtortw are forine<l l)y curmtrictioii. Thiwc not iiiiotuiinuiily lirt[i)H*n ii]K>n 
the saiuo plant in two iliireifiit foruis. With thia there nmy rJMj be forrna- 
tiou of ho callril cuiiidia, or wrCfiiuhiry &iwi-e8. Ilei-e belong the rut iui(l| 
gnsvw, U8 well as tliu rubt of gruin, and |>i\>lHibly the tu^verul ferniuntation ] 
or yeuatrfuugi. 



MvcoDEKMA ( Crypiococeiu^ Jlormiaeium^ Saceharomyr«4t). 

HBEft-^TAST {Mycrontccujs or Crt/j>tofr<KCt0t Or 7'orw/ri rmrriViV) con-i 
si»Ut of lai-^i' ((>,0(>4— (1,008 nun.), round, or uval colorltrss c«ll& which coq> 
tain oncj less often two, biigljt imcUar bodies resembling oil-globule-ii. ] 
Mycelium is wanting. Ki"oiu theso cells npw ivIIb arise by a jiroces** of J 
budding. The uew culU aritwr cither by cou»CricUou, two clinging together, [ 
or many new ones bud foilh, 8^> that an entire n>w of eelU Imuging one ta\ 
another is formed, but which are not traiisfoi-mcrl into proper filjuucnU.] 
The former is a Rub-fonu which is found during ferniDntation at at(.'tuijer-| 
ature less than lO' C, the latter a higher f*imi, which occnm at a tein|M.'r-J 
ature nbovu 10' C. They are found in diabetic urine, imd iu the 4x>nt«nta1 
of all pni'tfl of the digt^iirivr* caniil from thii mouth to the anus (coating ofl 
the tongue, vomit, diarrbc&ic stools) — Their pathological Biguilicanco is «tUl' 
doubtful. 

WisB-YEAST {Myc. vlni). 

Vl>EUAK-VE.\8T (Myc. (HVfi). 
MlLK-VKA-ST ( OUlittm faclifi). 

The last can grow fuDgus-tikc, if submerged, while upon th« surface i 
mycelium of cylindrical articulated filameiitii arifH'itf from wditch sliriotal 
grow up into the air, whose 1«>ul£ celU sejiarate I'tutily. Thr niilk-yeast l>e*l 
comes siiiiilur to lii>;htir foi iiui of iHier-yeu^t, when it conie-i in i-untjtct withJ 
solutions of niilk-nugar in a coutined atuioHphere. It is found iijion soufI 
milk, and especially iu the noiit fermmitatioii of milk-ougar, whure Uurtia| 
acid L» forniing. 

Soverftl opinions canoemln); tho oatnre of the veaat'fnujp prevnil. Sumo 
(SCUWASN, P.VffrKt:u. and othen<) conaldDr tliom orjraniiiinrt »>u gfurrln, which afi«6 
in fcrmnnbablc litjiiidR fmiu thnir own ftpecifio (TDnnM. Aeootding to Bati., Bos on- j 
HEN, Haij.iric, HofpmaN', and olhen;, thtjjr are only cniirlitionA. expooially of mould ' 
fun^ crccurring in fonnontahle Hqnidn, jiarticninrly the fipore-forniA, or epruuii <if 
fui^ wbicli Ut the htnii>«i>Ucre fnictifj' in other Cormn ; they originate likuwliM.- fnnu 
spores, it uiA> be from yeutt-ctrtls themselvea, ot Ccom uthor forms derelupud in tha 
air, when the; rvuch a liquid. 




M0rLD8. 



87 



PiLAMZKTOrS rUNOI, HypnOMYCETES. 

The mycelium of theso fungi consists of lengtliened, tvibuUr cells stniiig 
to one another in v»riuuH ways, vliicb form liJameDts and often preiiL-iit 
verj elegant, rfigiilarlv bninclit-i! tigiirc& The spores oripnate within the 
litiimi-'ntoiLfi parla, or on the end of tliem, and at muturity bc-c(>nic frw bv 
constriction. Here belong the fungus of the niuficardiue of tim ail k worms 
-tJiutrytiji hatfMifiiui), the potato disPiisa {^Ftuti^jMtrium Bolttni)^ the wini»* 

ii(»e diKeaae ( Ovlium I'ucluiri)^ mould, th« fungi of diaeusBH of the skiu 
and mucoui) uiembruues. 

Moi~i,i>'i.iKe i^)KM8 are: PeniciUiuni t/laucum, a. cTtutaceum^ common 
mould, iiencil-niould. 

It furnut tliK gniiti^st portion of the mould commonly occurring iipun 
slmodt all vfgi?t«ble dfcoui loosing substances {f.g, bryad, fruit), more rurely 
of that occurring upon uidmal MubstunoeR. Tiio erect fruit bearers, eross- 
|iartitionod, arc i-uitted u]ton aseptalv, abundantly and irregulaily braiicbfd, 
colorless mycelium. The points are tufted, and upon the ends of the 
branches are formed numerous avrl sba]ied sterygmata ; each of iheae 
becouies constricted into a long chain of s]iherical couidia, which nt first 

' conuuetedf and furnitih the pf ncil-shaped ap[M!a]-anct<. 

^IwpcfffUlua ijlnucua^ bluish-gn;eu mould, clnb-ifiauld. 

Found widt-dy spread, ehpefiully on old wood as a fine cobwebdikc gi'owth. 
It is fre<jueiitly found with the foregoing form, ft consists of ii similar 
myeeliuin. The fruit-tilameui» thereon, almi>st perpendicular^ and nioiitly 
inarticulate, are expuuded at their free extit?uiitiea into u club-sluijiod bncj- 
dian, on which stt-rygniata appear encircling it, aiid which by cout>trictiun 
fuintsh wries uf gtx'uuifth, fin*^ bristly spores. 

With :i8pergilliis there occurs un a mycelium the fturotium herbariontm^ 
once thought to be iltstinct, Siucfl both belong together, the fungus is now 
called <iifoliuin tuipi'rgiUu* fflatictia. 

Mne<tr mxwfhi and mucnr ratvnuiguji^ often fountl on excrement and *dd 
articles of food. The bludder-Iike Rwolleu fruit-hyphen (oUimellH') are 
ttpuu an abundantly blanched, I<ing-niaiiu-ut(^>us mycelium, which with age 
becomes 5i*ptate. Tlie nbunilant spores become free by the bui'sting or dia- 
soK'ing of the wall of the sjtorangium. 

Bb. ri.HPT-FiiNcl, scirizoliycETKS {Jiacteritim, Micrococcua). 

These belong to fungi, as far a« they are cellular plnnta, which are wanting 
in chlorophyll, and do not assimihite carbonic acid ; but they are distin- 
gnislied by the want of mycelium, aurl of basirlian an<l aacan spores. Their 
Lucreaae ia ordy in an ahexual nuumer, liy budding. Their distribution is 
extraordinarily great. Conmtcn atmospheric air, as well as wat<(r of all 
kinds, except fresh distiller] water, even snow water, and that from the 
uielting of pure ice, eiontain theii' geTius. The tissueH and fluids of the 
uomial hunuin body are free from them, with the exception of the skiu, 
and eadtr accessible mucous membiikucs. 



HifiboricaJIy nntewortlir are; LEErwEsnoRK. O. F, MCtJ-EII; of all others 
_£BRKXUMto <in 1*10 firrt iutrodaced tUo (atnilj of Lh« VihrwiteM ; in ISiH the four 
: liieUriuin, VArio, ^MT-wcAWrt, ^driOum) ; alio Dt'JAHDlN, Pastkub, IIaIj. 
IBK, Smobu. Coiin. 
' "n^ name, ikhio/mycttia fN.EGEi.1), is lugtj^stod hj Che great fragility of the 



as 



BACTKRIA. 



fonnRtions. The name IJtirterui i ITopvmas?!. mud othen), U aned bjr muBj ■yu oiy^ 

The diiwifioation of b»cterui with faii|ii Udlffcieiitijr rcoBivtilbydifFrr --■• ---*h^r»: 
meet pix>)'aMr they are to \j*s Mi)>arut«il from tfaera (N^OKl.l. Dk ' rr- 

nxsja, CuiiN), in ofipasition Ui H.KLi.TF.K, who regnrilt them ati y- . .or 

loiorococcua- Bwonn* of certain fnngi«(peiucilliam. et43.l — Consult N<v.<iki.i, lioOtn. 
Zh}., iaS7, p. 700. COHS, N<it*t. act. iiead. L^/p.^ XXIV. L Iiot.t/i. Ztg.^ 1«71, p. 
661. 

With respect bo (be extraonliuarily great imporumce which the acbizomyoetes 
already inijoy oh cauneN of tDdivitluB) <1tF«a«4iii, on well lui the oonfnnoo which exutt 
to the botanicnl and patholo^ionl dftU of this alupter, I |iTef«r, in thv following 
t>ot«nic«l portion, to follow- almost entirely the most rcoctit work of Coiin. 

According to IIoKFM iSN (Itofjin. Ztff . IWO. Xo. 15-17J, the kindsi of Mbiia- 
mjiratcB lirouifht forward by Ehukmicuu, DtJAltunt, Pastel'U. and others. paM 
iiit:4) imu aiitiLhor; |i«cid!aritiett which are Ui be buUI as uhaiactttriiiLic of Mm sjivciev, 
and trhii'h In \-nrioiiH nnvs cli«ng» in the roniiM? of dBvolopment iw ib«n> am rltiuigcs 
in the Ht-^mal conditiiins of liff*. R iacludes in the bRoteriui iteripK Qtc tonna : 
monodfl. rods, vibrloa, k'ptocbrix mad zoof^n. AH theao an fotiod to iip|>car to- 
(fotbci in iutuflioufe; tbuae which have been pulrifying for moutba. are richer is 
thti Itu^tr fomia Uuul Uio«e which have undergone deconipoulion only for * short 
dine, 

BAirTEBiA are cells destitute of chlorophyll, with a globular, oblong or 
Cfliudiicul, t»*ist<?d or curved foiTO, which inci-easo exclusively hy trnns- 
viTse divi^iuIl, iinil vtigflate lit au isulated niimner (sijigle-t.*ell bact.) or in 
cell-fumlUex (filaniotitouft bact.) Biu:t«rian ccIIh jKHtspsfi a nitiogfiiousj 
moatty colurleaa pr^itupliuim^ which is nioit^ strongly rofracttvc thiui watrr, 
and fur the mtMtt part contmiiK Khining fut-like gnumh's. TUc non-ulbnuii- 
nouB but celliiloKi> tike ctill nieinbmue hi not destroyed by pnrn±u^u and axa- 
monia, nor by acids, and resists pntrofuction fur a Acr%* long time. One 
gniup of bacti'ria forms jelly-like imiRftcs (jeoiigliia). tlie other group coiuists 
of bactfrift M'hicb are frut-ly dij)])crbed, or occur in swarms. 

In the glolmlar and nxl-shaped hai^teria, the daiiKbter-oeUs are, a« a rule, separated 

inim<Mliat«-ly aft<'r division; numetimex. hnwever. the cell-g*in«ratii?na rpmnin oon- 
nwt^-d, whilxt th^ir ci'll-Tncmljrancs mvcll up into jelly-like limpid intcrwilnlar KOb- 
■tancr, and arc nnited irt/i larsjrr. nhnrply -defined, o1a$tic. supple. jo!Iy-Uke mowca; 
MMKiLoA. L'fUl.N. Th€«e conslltutediffii-sfi OT forme*!, irrcLndarly j,'lrtlmlar. cla«t«red or 
pouchlikit, lubt;d or br.uicliinl jrlly-llkft maMWM Awiiniiiiiig in waiiir or aprend out 
upon n KuhHtriiLu:n. and in which hAct^jriiui cells aR> incloMjd in varying ]iru|mrtton)i. 
^n tli«w6 jelly-IiVe zongV-a the bacteria di\-i(I« still farther; when lisiwcially rapid 
incrcarte t-'ikiw plnce, the younjf oell^ ore very clooely pressed affiant one auothiBr. 
and the iutvrcrlluJur tiulMtauce ui little dcvelup«d ; luter the cells Kvparat«. To 
tbf lukcd eye the jelly Ukt: ma«eH appear na oulorlcm lloccnU dwimmint; in water, 
which arc dt«podite<l upon the external surface, waits, or bottom of a v^'^ael, when 
gTtmtly incmuied, forming jidly-litce nuu»es, nr thioJc f^Ktly memhranoR nf many c«nt. 
to circuinfr-ninco. If the water containn Iron in (lolution, thin in rcndilr pixM-tpitated 
as an oxyhydiate. «id the jelly is colored reddish-brown. If sulplni retted hydiogen 
is gcupratod in tfaiN wat^r, the ni^ty-browu 20i>gl a are blackcniMl ai> iu «tw)ited well- 
wulor. The UicU-ria cellx, iinltedded in the jvlly>lll(t! t-ubeiLauce, do uol pert^ since 
tht-y not only ineroiUMj very ijitftUy, but aUo eawily free thuiinwlrea by ^(jlutifju of the 
jelly, ami thpo they nwiin freuly in all direc.'tkin't in the water. The filamentons and 
screw- bacteha never occur in jelly-masses, but scattered or in sTnuinfi 

The forinatiiii of swnnns occup* in all bacteria, if they congreifate within a 
liquid in euiii«n(ueiicu of nbuiidoat ni^uritihmeut, or huufreriiig fnt oxy^tu rise to the 
RUtfaoe of it iu endUwt uiultitudce^ The bacteria swarui in disuntfuunhed from the jully- 
like xoogl-'ia Viy the fact that the cella of tJie latter arc immornbly comonleJ by the 
interoellular HnbfftAiioe. On thin noconnt the zooglda in water have a chi»r]ily defined, 
for the most part spherical contour, which appc»arfi so much the more distinct, iie* 
cause the Ijixetcria cells are more densely detM>si ted on the wallfi of the jrlly like moM, 
than iu the middle uf it. The bacterinn Htviurtiui, on the other huud. cxu; merely as 
True, movable oella, but which oft«n are no deunely congregated tbut Lhey almuat 
come iu oontaot, thereby forming a mncoits nuun ; in moving water tlis iudividiud 



GLOBULAR BACI'ERIA. 



S9 



ocQs dicpcne, adnoe they ar« held together by uo intermedmte snluttAucc. lu frei>h 
watex the bacicriiui svarme Lie for the mont pnrt iit^nr the surface, vfteii iu a liirKu 
muM, one oeutimetro thick aiid oluK-ist oIcn^Dttuu, which peuetmUB liki^ Mliiiiv-}<-uin 
into the iltM:]>cr Lhiu ^Rtrtiuu of Lh« liqiiiil. Uu ihu nurfuju uf Uquiii!*, in whiuh hiw 
tcria propagnie. there evre, aw s rulu, very Uiin Lritli^rtc<;nb jtfllio]e«, tu which inotionlcsa 
bwt<>nn arn nften very regnlarly arriuigud to parallel rowH. The pflliclcf^ arc diatio- 
pnif^hcd from tho- 2ooj;l<-a by thn foot, thftt in tht- Utt«r tho celU nro unit«l into >flnb- 
iilar maM«e« by Interefllulnr inibiitJinc<<, vhiUt in the former, oaly a altii^e layer !■ 
l>ti:wut withont intenncdiate inbKtaDoe. 

Att<ith»-r form in wltiuh hact^^rfn appear. U thaC of a piilvcruWnt. pr««:i|>itate. 
Am iHinn lui thi^ tiiiiritivu iiiaL<)n:Ll ilk a lii|iHd in trxiiuiiHLud, t.\w fnrtlier incmiae uf 
bacterin ii* nrreKtcL and the liille tn.xli<-M ure: yrndiially pirtiipi tilted to the bottom of 
the vewKl ; the liquid beiv>nies deurer. eurlivKt at the snrf&ee. ihe whiu? powdery 
mam at the bottom becomes thicker and deiiM-i. AU kiudu of luu^tt^jia tue iiidiA- 
CTOoinately mixed lu tlic prceipitntv ; they arc rnily portly <Ic:id, for thu luoub jiart 
they are iu a state uf ipuemotiiice, like yeiutt-oells iii a fermeutud liiintd. 

Most bacteria exist^ iu a muvaUe and a motioiileetH state. The laove- 
meul ocuisiiits ill a rotation about tho long axis, to wliJL^h iu tUe longer and 
more KUpple forttiK aro also addeil tu^tivo au<) piisHLve iiiirveineiitn, and 
strrtcliiiigs in the direction of tim length of iim filament, iitiver fljiii-ol 
inikVf uu-uU. Motion ajtjieare couneclfnl with the |irfst-nc« of ox^igen ; ia 
the )itiM(;iii^<! of oxy^i'ii the condition i» ono of ri:^t. The motionlttsa tttate 
is lasting, if the bueU-iia are iiiuttid iuto jelly-like masses or pelliclca; in 
globular aud certain tilumentuua bncteria mutiou ia nuvcr observed. 

It in rluulitful whether «tiore or couidiftQ fomi.ition takes place in bacteria.-^ 
Consult RlSDPl.Klftf H. IVr<*/i. AreJt., IS73. LIV., p. :ilW. 

ltB<iteria (uMpeoiully f<firl Uruut) duvehip aud iticriuute in au extraordinary numacr 
tit a Bo-called natritive liquid, wbieti ik free from nlbuminoas coiiipouiidi> and autfar, 
Ijat eontAinfl Iteiddefl n certain quantity of mineral RUlwtancei (phciApht^rto acid, |»o- 
tiw, Milphnnc aetd. lime and niat^nesiai only ammonia, or tartarie acid : the for- 
mer U tlie nitTtiffHitoiiH, UiH latter the carbou uritirufl nf liiicteria. Tartaric acid nuiy 
also be KtipidanteU by any uri;auic compound uf earbou, with the eKception of car- 
bonk) add. 



L ORODP: SpnERO-HACTEIllA. ClL01It*r.AR BALTEttlA. 

(PAflTsni's Jivnm, or .Vi/co^rm/t. EiiitENitKicn'fi Vnnas crrptueulttm and prodigi- 
«mM, Hoppjux's MoiuM ertipuaculum. Uallikk's Mieroeneeiu.) 

Clobulak BA<.n'EitiA ure spherical or ovhI ct:\\%^ mostly uudor 0,001 mm. 
in tdxe, without granular contend, with a uiruibrane possohsiiig a double 
coutonr. The cidU are connected in pairs, and at the point of division are 
deeply c»tn«tricted. By progreHsive diviMon there are fnrmrd short chains 
of ^, 4 ^1 8 and more ]mrtj4, whioli arc titiff iirid beutt uuil, iu ciuisefjiienuu 
of the conKtrietions, inoniliform. t)r, tlio chaiufl are irregnlai'ly broken^ 
zigxag, anti thuft there ure foruied dense and confutu'd utTuninlutionK of 
cellA, colonie-s, which cxjrwjst of u great imniber of cells, and are iiT<'giilRrIy 
itrranged with rettjHKt tu oue unutber. Or, timtlly^ the thiughter-cellK arin- 
ing from thin division into two», ilo not arriuige lIieniHelvuH iii chains, 
bat At onco form irregular deposits IteHide the mother ceils, and ai-e con- 
nected with them by intorcollular subittance. Thim are formed masses of 
numberless globular cells, which form jelly-like, oft^-n very tough, iibrous, 
drt)[>-like, or membranous mucous mus,ses. This tnueoua fomiation is the 
nuruuU foi-m aJiaumed by those kiiuU which apjK-tir in pathological pro- 
Gf^sftcs, ami which cover the tlitteaHcd urgiins in a denw* layer, or are depos* 
ifced into the infei-HticM* of tlm tiwuteH. (ThiK condition (vtrreKpiuida to the 
sougloM-furm uf the rod-baeteiiu, but is distinguished from it mostly by tho 
leas development of lutorceUular subiitaactj ; in consequence of which tho 






OIjOBCT-AE bacteria — MICKOOOOOCfl, 

globular cells are closely iireswU together, wiJ present under tlie microscope 
nn c'xtreiriely characteristic, closely punctated or finely grruiuUr, shagi'ccu- 
Liko appearance.) 

It is flifSuEilt to rlifllin^iiRli g1(>liiila.r lini^riA from tim Atnorpbons. pnWnrulent, 
raolp«nlar dr*|HiHit nlulritiiH) nf Uii* mfiHi rarioiiH orgTUiui mid inorganic HuhRtAuues 
(oDTbocata aud oxalate o( lime, Tvnin, mdia iuk, but titijMictally &om futtj and alba- 
minona sobstascea. ) 

Ktiip.R {Dfi'jp. rnrd. ZUcUr,, 18W, III. 1 It., p. 14) rpgarilB on vegetable forma only 
thoiip iwtliiU-il irrajiului vrhich arc imiriilrd witli cilia. Th<j ^aiia]c« of ($Tauular 
coaf;iil»t«d tllimi dtMtolv^d \\y tbc ml<liti<m uf a<x>tii^ auid. the nioleciile« of gnuiulax 
de^oimniled hepatic and rMud epiihelmm, the granules (fenerat«d iu hyalinii, mucva 
fay acctio acid, the pigment mtnlecolea of the rhoroid— all hare a globular nuclena and 
theiz inoett^iuil moLiuu. thu Urounouiau molecular nioTtimoot, la aoi to bo *' ' 
gniifaad from tlio movoiui-iit of the micrococoua. Host oC tbeaograLttleaare 
or rendered pule in acidi* and camitit: alkaliex more easily than the miorooocona. 
the pi^nent granules of the ciion>id aiu more rcitiiKtaut tlian the latt*>r. The arresfc 
of the movement by the action of <.-onci-ntmU-d aciilR and oanstio alkalteM leadA K. to 
conclude, that the little bodies having beeoiae softer, aud the medium simoltaneniMly 
more dt'DKe. the movements proiluccd hy ordixiaiy jar* of new cnrrf>nt<> in rhc tluid 
eHcapeunr nenneji. but wiUi a high mii^aiifytiig power are Heen aa a ~ nbUug or 

turning'. K. holds the vital nu'venif-'iit nf Ui'- miciooticciiB not to - i niojec- 

nlar niovemcDt generally. —Couault aliw I-KX v^- ZUeJtr.f. Ojf. Gt*:i-'n<"-'j'ji.t IBTi, 
IV.. p. -17). 

BiHidv« by their form and movemeat, globular baotorla are to be diatingniahed 
from rod-hacteiia by their function, 

Ibt Gbnu8. MicBtx^ocius, Cony. 

Colls colorless or slightly colored^ very small, globular or oval, united by 
ti*asvprse division into short niouiliform filumeuts of two or more mem- 
bcni {mycothrlx^ tonUa-^forriui), or iuto luany-celltjii families (coluuies. bHlla, 
hea|>a) ur into mucous mHHsea i^zootjf'ia-funn^ rn}/cod'tr»irt'J'orm}t WtTUOtn" 

MOVF.IIEVT. 

Tu thi.s gL^nua belong the following tlirct; " physiological tqtectes,*^ since 
the (ILstiuction as to furtii and size is ver^' (linietilt. 

JU PIi,l.MKST BAiTERIA ; rhrowoijimir glohtilrtr Inicleria ^ c/irontufftmic Jorm9 
of mirrocuectt$f globular bacUitriH, which aj){»car in ooloretl jeUy-uke miuiies. 

They Tegetate in the form of xooglna (royooderma of PA&TBCm)^ They form mn- 
coua mncasA, uhicti in f'or>u>i^nence of a very quick ceil-faicrease, deveUip in a ithort 
time urnn the »urraoe of their aometimos liquid. aometimpA solid, nimtlr organic 
nutritive HulMtauuf ; and the}' aiu somi-.limeM Lx>ui|>letc:ly etivelopvd iu L-olorlesct muouN. 
I'iginuut iHuurti only iu L-uutact with uir. All enratv au alltnliue reucliou. Air alwaya 
contuiu^ ^rrm^ of th(>He Vnicterio. The fpuiuratiLiQ uf pi|^uent is uot a rcatilt uf e*.' 
temal I'onditionfl (Taricty in noariahnteut, etc.), but of spceitic and tranamittod pe- 
culiaritjea. 

m. iNM>M.)Rt.B coLORiHa MATTRH9 (red and jelJow). 

1. Mierveueetu prodigi^aut. Coax [iwruu prvd. Biuukhberci. PaluuU/t prwi.), 

Ciiujitm of the (teeming bliMfd-t^ba which aoraatimes during moiafcure appear on 
vafent, breail, potat.oc«, etc. 

2. MifroMciU* lutea*, 0. 

0. soi.crni.R roi.OHt:ca matters (orange, greeo. and blue). 

8. *l. 5. rt. Mimrirficcm anranUactua, m. chlorimia, m. ej/anfu*. m. vicitiMUii. 

Thew do nut belong to the glnlmlar baeUiri.i which color milk htue and yellow, 
and pui like verdigris {tUtrio gyiixantAuA, etc. EUK., baeUrridiatn arugiHf*t3ti 
SCniltiETER). 



h. ZYMOOENIC GLUBVI.AB BACTERIA. 



QLOBULAB BACTEftU — MIOBOCOOCCS. 



91 



7. MirROCOCOUB urEjE: fennenb of the urine ; fei'ment of luumonutoul fer- 
nieututiaii. 

From the leseiirobes of Pastepr, t. TreonKM and Cons, it appRara that fraith acul 
urine, afu-r haviDg Mood exposed for two Unyn at a temperature of •10^ C, in tJmidy 
ttMOi <l<r>L*lojtmKiiL of (flnliuliir liiicWiriii, wlucli stipurftU- us globulta or oval cells, 
•wiio about, or lt•^c'OI^e conne<^tp<l by twtwi, ruitm, ui^^btjt, clialu-like (lorulu-funn) 
«tc Later, rod und filamentuui bacteria ali*u ii|i{>eiir. 

c. PATHOOENic GLOBULAR PACTERIA : *' feimeiita of contagion.'* 
S. MicKOcocofa VACi.'lN.E {iHicroapha-ra vaccinas^ Coiis). 

SeMftrcbw of Zcrn, Hallieb, Kkbkh. Weioebt, Ootnr. 

9. Mioaococcus DirnTueuiuus, according to nuuiy the cttuse of diph" 
theria (vide if'ra.) 

10. Mli'RO'OOLxa SEPTlctTH {9niero»j>oron «a/><urum^ klbbb), according to 
m&uj the causv of pyictniiL. 

11. Micnocoectis Bosinrcis (miorw^Md boiab., BficuAMP). 

The canfte of a very >l«Hlnictiv« epiilcmic- amon^c tbe Bilk-womu of lontliQm 
France, hut altogether ditTcrent from m ■/>■*< rfWiVi<r and yiittiue. 

Tb« iaiaro4»Kxii9 eApecinlly bos in later yfn\n bwn Uie aubj«ct of tbo tuoat zealous 
inquir}'. It appenrx In mictottcopic tuvealij^tioiw with extmotdiuary frc-i|uejii:y, 
Home •pcciiueii8 uIiuuhI everywUL-rt;. wljeu tboy ore looked for io u not cutirwly fnsb 
part of the t>ody; it i» pnitmbly also con»Ut.nl in xomo coatat?i<>^is fronrral diH- 
m^rn If the micrococimA happpnA in great <|uantity within a blomlTuwel, it in most 
eaflily recti^ized by itx din position, by tbu |>cculinr ^malluvM. th« brjghtncwi, etc, 
of iu individual cl<-incDtn. It is uot clmn^'td by utcohul, uUior, chloroform, oaoatlo 
alkalies), and not too conooiitratcd ocida. Iodine colors it yellow ; caruiiiie and 
ba;iuaU>xyliD sometimes c(ilr>r it. xoiiietimeH nut. If. ou tlie other hand, tliu micro- 
cdccuh iHX'urs Kin^y. ut in ttio small iiumbent fctre from or trttbin chIU, the diatinntion 
between it and ollmr forms of roolecoles is oftt>n impo«sibl«. 

LCliKHHBod Hk>8IvN {Arfii.f. micr. Anat., IHtiT, IIL. pp. ^18, 343) fonod in th« 
b]oo4 of he*ltby dogs, which hod been withdrawn with all precnution. after it had 
hU-otl for thrott days at W C, viUriiM, while in tht* iuim« blood which had Xwf.u kept 
cold, til ey wen- (oniid wanLiiig. Ki.EUt* (Anh. f. «j-j). Path., \STA, I., p. HI) with 
like precautions fuiNMl to find tbom in the blood of healthy do^. 

A complete isolation of iniorooocci has uot yet been possible; the demonstratiug 
experimeuu of many have not Usen (•utoessful in the hand of others. (JnAi'VKAU, 
■a wt^U as t)rBlM)N-R ANDERSON, finbniitted vaccine ]ym|ih tti tht; ni>«miiun uf (gravity ; 
the npiwrmont layen wvrt^ alto^thcr inopemlive, the deepest (which cuntaint-d Che 
fnngii very effective. TiKOKi, (tVA. d. fiiherrrr^g. Eiff«ti*cJi. d Afi^rxtirp. 8(pt. Bern, 
Diwi.. IK71) noii^'ht to stjparate by filtration by clay colls, the con^uwulai cleuK-iits 
from fluids uf );au);rcne of the hpk-cn containing bnctoria, an welt an fr»m seplic 
Uuida. Bkhomasn (U 'At»chr,f. (.'hir., 1«;2, I., p. 31W) found that by freetiug and 
thawing out u liquid containing bnuturin, Uio liquid becomes separated into layers, and 
the snrfuoft Ut the tlepth of iiome lines is free from bacteria M. Wkcff {Jued. Ceu- 
tmlhi., 1^1. \(w, »J. Ilj found by the Zaiin-Tikqel method of filtration, a few bao- 
tcrin and micrococci always present iu the filtrate : It coutoluod, after throe or four 
~ay>< a» n uew eultivatiou the oi^itiiiHiuH tu gr^ut abuudouoa. The clay-cells thun do 
Hot pri'vcnt thn pii.«.-iiigf- of ttJicteria. Wiii.Kt' likewise had litUe success wiUi llKun- 
' JI.\K>'- ' MILT metbwl for isolatitm of hacterin. as well as with repeutwJ filtrutions. 

Ki : , /. rj/i. huh.. IfSiiS. I., p '6\) cxpcriiueutcd witU the cultivation of 

fai» '/. afptienm in iniii^^'lium ^fluu. Tbust: expttiiiienti dJIfer an to tbo 

kuDH-u ciiidiMuus enUrijly. Proliferaiinii proceeds from the rod'like motionlt^s^ 
boilies, haotcria, which probably by prngreRaiTe splittings in the Inng axis, give rise 
to " groups of iAolnted bacteria." By active division individual bacteria disappear, 
then nnnc "granular plasma halls." Farther on then.- appt^ars a 'Uffcrouliation of 
their contents; a pArt booomcs bacteriau colonics, othi^m remain houioguuLOUH, have 
a dull and yclluwish ap]>eanuice, bear protnpliijjinic proceiuteN aii<l appear omtrautile : 
'* coutraclilu pigmout-boJieii." The last stage consistii iu the formation of azi 
bomugBueoiu inass, in wbioh ant found neither pigment granalvs uoi baolorjaa cUo- 



99 



[TOROBAGTEBIA. 



niea: "plamna-IaTer." From this the same development may prooncl aiMW M flMl'' 

tho flmt-iutroduceti genun. 

n. RrOPP: MlCRO&AtT£BIA : — aOD-LIKE BVCTEUIA. 

Beaemblo globular tMi'l^t-ia iu Uio siiiaII size of their cells, on<l l\xo\e 
teiniwrar}' union iuto jellv-liko or miicnas miissas, but, apart from thi-ir 
jilivRiolojjical aetivitT, they are tliittuiguuibeU by their tiliurt cyliutlrical form^ 
and the spontaut'ous movfni»mt of tbeii- cells. 

2. Genim, BACTEUlfM sen^ni «tr. Coits. 

Short cvUinlrical or elliptical cells, wliicli during (u.';;iuentntton are 
connected in pairH ; the daujL,'htt*r-cells separate after eumplt-tt* division; 
rarely they nptin divide Ijeforo ihey linre bocorun isolatcsl, mid then four 
ccIIk lire futiml in niie r<iw. The cells enjoy a lively spontuoeous motioa 
throu;*h abundant nutniivo sup[ily and ucci^u of oxygen, so that times of 
rest arc of^en succeeded suddenly by motion. They do not form lOiaiiis or 
filaments (ihun do not appear in fomi uf leptotltrix or tonila), but vef^^tat^ 
to form jelly-like iiumwis (zoogliia-forni), which aro distingm:ihMfi fnun thuiw 
of globular bacteria by an abundunt and pernmnent intermediate substtmce. 

1. BACTERIUM TEHHO, EUKENBKKG, Dt'JARDIN. 

Cells tihnrt, cylindrical, oblong, clear glistening or bliwiVish according to 
ptifiitiou, thii Nieiiibmiio coniparatively thick. Mostly connected iu pro- 
gressive division or in paii-s. for the most [lart only 4),()0I.'> mm. bnig, 
^ — I as broad. They till up water in counties.^ myriads as »o»)n iw pntre- 
fuctiou umtter is prehenl, and IncreaHt: as long as putrefaction goes on, and 
disap[>ear a<4 Soon as it' stops. ^' Bact. teruio is the ferment of jiutrefaction, 
the saprogenous ferment." 

The ccIU turn on their long nxis and swim forwarfl. then return a little or travel 
ta curvL^ Iiu4>fl throat^h the water, for the moxt part not V'-ry qaiekly. i» if trntabliug 
or wavering, ahw cihuutlug forward with sadden springs, th«u a^iuxx beoonuug^ (}uicit 
for a loag tiniu. 

2. BAiTBKit'M LiSKOLA, CoHN. ( Vihrio Hn^foUt^ EujtfiL Duj.). 

Cells distiuolly cylindricul, 0,0038 to 0.0052 mm. long, to O,00ir) mm. 
broad, straight, rai*ely somewhat curved, with sti-oiigly tetVactive, t'oft con- 
tents which are aLso abundantly tilled with fat-like granules, and thereby 
tlarkly punctated. They are single or connected in pairs. They fonn 
zooglija-form mashes like bnri, itm%o. 

Tbey move like b. tormo, but more gtroagl^, »vrim about ono end tremblingly or 
in curv«d Uuea. alt«ruiiUil,v forward aud Ijuclcward, eto. 

Klkhs (I. c, ) rt^arrlut r^ul-bacteria uf a phano of dovelopment of globiilAr iMioterto. 
Hm rc!^ar.](( both at miomUaotovia with tliH following charactuni : celLs cuIoriaMw or 
fot'biy colored, vcTy gniafl, jrlnbiilar or oval (microooccua). vrhiub uiiiLe iat*> many- 
ocllcd families (loogloo.i. Within the Utter the miorooouci ^row into lodflhapod 
forma (baotarla), which bocome free and fre«l/ movahle. 

III. Group: desxddactrria : — pilauestoub baitkria. 

Consist of elongated cylindrical jMirts, which if isolated, are similar to 6. 
tin. but tbt-y iacrease by transverjtt- divit^iun, and form by uniting, lnngi«r or 
shorter chaiiis or fihiments. The niameuts are not constricted at the juinMt 
like the moniliform chains (tortUaform) of the globular btiutenH^ but 
throughout cylindrical (lept<tthnx fihuueuts). They often funu swaiins, 
never zooglua form masses. Thoir atate of motion and rest changes with 



SriROUACTEKIA. 



m 



n^oonMSecT oxj'gen, otc ; certain funwa Hpi»ear never to be movable 
{b'ft''ri'/i>rin, Dav.). 

3. GfliUS. Bai ILLt8. 

FUmiieiits ntr&i};)it. 

1. nArii.u;s srormis, Coiix ( T7/)?*ro gtihtitis, Efir.), butyric-ndd ferment. 
KilmiieritH very tliiu aud teiiiler, lu'iice ilie iirticiilMiion im wen witli tlif- 

fitriilty; the single nttiotilutioiiH are luoKtly O.OUU uiiti. long, »on»:tim(:^ 
isulutft! (lli(,ii iliitiiii^uisliecl witli dirtji'ulty from h. /i«<w/«), soiuttimea wmie 
up uf two ATtiaulatiim.'f or forming still longer rows. KiUnieut^ iii high 
cU-grpe supple, actively nntl piUfHivcly. 

Th«j Mwiia atnit^it, with altemating refife, ROiuetimeH clanuoly, itometimes quickly 
WmI driU^rouKly, tliKu back again without tiirinn; anmarl, They Lum uimUuuoUjr 
•bout tlieir axif. The fttamentJt for tho m»itt petrb luako vioible pcudalam Ulcc iiiore- 
menta abi-iut a yarymif puuil in tho leii^tJi of the filamuut. 

2. BAi'iLi.Ui» ANTHHAris, bucteriUiu of gaugreiiti of the aplueii (DAVAnn). 
Very oituiUr to tbe precetliug. 

3. BALlLl.t-S I'LSA. 

FiJaint<nt(i tliiokt^' itnd stilf, with dense finely granular plasma. 

4. (lenuH. \'iBRio. 

FiUiuonlM wavy : eiUtor titick wltli Hingle ctirriag {vihrio rtif/u^a), or 
tbin with many wavy curves {vibria iterpenit). 

W. GbOUP : SPIROBACTERIA : — SI.*ftEW-BACTERIA, 

Tbey are diHiinguibhed from vibrio^ Coqx, by the closer and narrow<ir, 
Tegtibtr, pf'rtnanent spiral uf tli» HlftniHiit. TIih varinuH fumiM occur niosttv 
■u cfimjMiny togetlii>r. They itp[>tMr only in intuaiouK for which river*Wjtii-r 
18 ffiupliiyitl. 

Tv Uenns. SPISOCH..STA, with a more flexible and longer closely^wouud 
spiml. 

si'iiiocn^fiTA PLtCATiLis. In tartar from the toetli. 

ti. Cieuus. spiuittt'M. TVitb Htiffer, shorter, and nwre distant H^)inU. 

JSph'Ulum t^Tm-Tf apir. utidid<t^ ajjir. volutans. 

A. specinl nrrangentt^ut inotudos tbe following plants: leptothrix and 
samna. 

LKPTOTHRIX BtlClTAMS. 

Conaistd of long, very slender (0,000!) mm.) simple filamt>nta which are 
dividvd by partition walla, and vei-y brittle. In t'very one it uccurs upon the 
finely granular masseB uf decompoHition within thti' luoulh (Kummit of the 
pajfilla* of tlin tongue, sediments arointd !bo t^wth, tartar); in gn^at mussea 
iu tlwj sick, with (hick bi-own coating <m the tcingne (tyidiuH), C'onKtaut in 
the iiit/^titiCA, and in the fcoi-R, Very fre(|uont in th«; vaj^iua, sontetinies iu 
the lachrymal dnct«. Without special local puthological uiguiliciincL', bub 
the cauMe, )>erha(i», of caries uf the tveth. 

McMt o>MicrYffrn admit n fUaninnt fnrtnntion In all bact'^rLa without dixtinrttifin ; 
CoKX does not. Th«t chain* of glutinlikr htuTU«ria are <lLMlirii,'iimht.'il fnnu lt.'pt*iLhrix- 
famtM nf fllametitnUH )Nu*Uiria hy the (act llmt tho latter arc not coitauncletl at the 
articalaUouB. 

AjiX'onling lo L Hatkr ^^f'fU'ltM^^l^r. f, OehurUk., XX.. p. 3) and othcra. a umilar 
paraaite etiuMKtiiuc of broad ftliimrnlfi ucinirKii]»o iu ih« nortiial luid niorlml nct^rvtions 
of the vnlva iin<.I riifrina. According to Wim'KKI. (£fcW. kl. Wocfu'nKfhr.^ iHllfi, No. 
33) t>ic hro I ' ' . ily Tarety have in prepDant women aay other results than, per- 

hai'A, h,r|» : '.iicreased McretioD. 

A poramt^ : ^..^gthe L^pt'wu'rtumtt^ritad mud utcrini was found liy L. MatBR 

(L Cj npou tbe inner smrfaco of Uic Uibia and in bbc vagina. It funna apvUi, whitifJi gx 



94 



LEPTOTHRIX — SAKCISA. 



jelloviali, u n rale. looaclj dictrilnitcd upon the mnoonit nienibran(>. mnntleH nr ir- 
regularly f'Tmed. with a dinmeu>rof from 4 to tdmiii., FeBctoliIiiij; [i.itchefl nf thnuh 
Sometimeji the^cxiver thmw'iljcat FtnrfnotiH. livtm often Uicj ndberv Vikv diplitbuntn 
membranes tu the rnacoos inembnine, atid when rumovud leuvu liobiud ttu|H*rftcia] 
ulucn. 

AccordinK to Lkrkh nod RoTTBXtiTKrs fVnUrt, lift. rf. Cnrif* drr Z*tltn«., IS67) 
cvie* oC ttiu tectli depctidn ujicd the ^[lowth of Ujttot/trit: bueatiis. lu the iiilrrioraf 
the cnlar^il tubuH of the tct;th gronuIcA of fuu(^s are foiiud. wbich can cxpanil tho 
canfllx into broad pmicb(>s; tbeti originaU) jirouuwcM filled with fungi, which prtxnire 
the rcmlting comjitcto deony of the tonth. At the oomroi^n cement nf caricH the 
ennmot and doDtine are, by meond of the KporoK ( which originnto pr«fcrnblr in the 
mouth throngh various processoH of fcrmrntatioD), attacked in the «amc plaoe, be- 
come dofteued and thereby prepared for the entrance of the fundus. < Ai-cordiuj^ to 
othnn. cheitiicjil (tul>»<taJiue«, especially ucidtt, dextror living as well as de^/l teeth ) 

FoR!*TRR {Arrh.f. fti>th.. XV.. p »lHi and v. rrRAEPE (/A. p .134) niw t,;ttuthrix 
fn the lachrymal dnctit. aod. a« a result, 4tiUicldiiim and entiirrh of the lacbt^mol 
diick). 

Lkiieii (J/(!ri Clrihl, 1K73., Xo. B) icdaced by inoculation of maMes of lepto- 
thnx lout of the normal oral cavityj upon the conica of a rnbbit, a very intenne hy- 
popyon -kemtilitf, aimilar to that of mun : micToi«copii»tly, a drn^e inflliration of pnn. 
but uo funjfus ffiowth. The ideutity of Leiikk')* diB**ae« with liBEitTli'M diphth»-'ritia 
of the ooruca in ((uostiouable. Probably, however, pn^ressive Auppurativir kcraUtt* 
of man amcH by -cptiu lEifection. ba many aue». pcrhafw, from the docompoxiug att- 
crctinnn of tbr hichr^'iniil pn^nof^cs, in dtHeaHCii of Uti^se parta. 

The UtWofrxn^ luii^X »re doubtful, barintj* \>i^*-u found nt tlie meet only once Or few 
tiince; LriitomilnA iiiftjifiiliiM <;Ravkh); l,rj}iumiUi» Jlitunor^n ; LfjtUanJhtM ejtitlerontUi 
(UCBl.Klt); Ltrfitoiiut"^ utfrl (LnHiiltT) ; Lr}>t^nHtM m»ci uUruii i\VtLS.tssos); 
LeptomUuM ocuU; OaeiUaria intcstiai (Farke). 

SARclNA VESTRICULI, (GooDslu) : — SAttciNA. {Meritmopoedia punctnUi 9, 
verUrtcuJi. ) 

Forins 4, ft, Ifl, 6i-(eic.) ftild flat cuhicnl celU witli an average aixc of 0,01 
mm., each of wlitch is usually 'Uvi<ltMl ili>t>|k)y into four \\Mti and for tke 
mottt [mrt cuntiiitiH 2 or 4 pale or slijjhtty nnltlUK nuclei : it Ls hi-IiIiiiu with- 
out nuclei. Tlwy lie togt^ther in ctiijicAl svmnioirifriil hcH|i.s. Out of these 
wWn, rnunik'tl cuUh are ul fii-Ht forniwl through continuous ipiadrupb- stran- 
j^uhitiiru ami division. The cells lire lu^ivier tlmn waU^r nn<l hink in li<{ni<ls. 
It occurs espopiatly in the fluids of the atomacli (vouiitK), W'hh often ia 
the duids of th(j luteKtinee (diarrhueic stools), in the mnue, in pus, and frtid 
liquids in vui'ious localities. It Is probably fur Uiu most i*nri without 
palliologicul aignilicance. 

Whether the f>aroi[i2e ocoarring in different localitips beloHK to the wine fpecie« il 
not anrtrly determined. .Vcourding to lT(*iO!*oUN ( I'l'rr/i. ArrA. XIII,. p. '»4l) saroi* 
na orijrinaUw fi-otn some one of the Otfi'Litorijr. several speoiee nf which oucitr in 
onr ftpringa. Aooording to Wkisk {flet-i. Id. H'VAr., 1H70, Xo. '■i\\, probably from 
JJi'itt/m-ifi'K and m U neither a true animal uor TC{,^:tnbte form. Ue propoBcs for it 
the name of Ffntuli ctuft'teuH. 

Aecunling to CoilN 1 1, e.) Karclua la a geuoji of the neAiprniffCfta / it diTides crosa- 
Vfiite by partJtion)«. tiaetrria only tnivHrMoly. CoKN «aw KnroiniD oat«ide the human 
organism on rooked pntatoen. an did also Ln^tToiiKKii in the bloml- 

Ab Pnemntmovitftt*/* virc'.nitn Vmi-iH)W < Areh. IX, p. JJ?*, S. p. 401) and 
OoilNUKIM \ht. XXXIII.. p. 157) have dcaerilu^ cftMW in which the wircinu wu pro* 
bflbly the cau.se of pulinrmary pingre:ie. In other casus it had donbtleas passod oat 
of the r^toinach'into the 1un^.4 (Zknkck and others). 

In whfl.t followg, we fthall consider the vt^table pamaltcs with respocc 
to their relations to the human b;>dy. lliennii, on acoo.int of our 
imperfect hotnnical and pathologienl knowledge, there exist manifold un- 
eertdiuti's, and ^petitions aiunoC be avoided. 



DISEA6K6 FKOU MOULDS. 



95 



1. The bO'CALLED uocld-disease?, or MMcrtsGs. 

Tho mould disooseR arc conditional upon the aliorisnieiitionod mould- 
fungi. Thfy are all called frum tlieir locality : l>t!riiuit«-, Pucumoiiu-, 
(etc.) inyi^osis »fii>er|jiniiia. TUt^y owur firet of all only «|»on imrtH MlTt-cteii 
witii nocrosis, or otlierltwiona, iiarticuliirly upoti ulceis of ibt!«kin (iiicl. tlio 
BAilt and Hxtcriial orgitim of kearing) Htid of mucous au'iiibi-flm*^, a« well aa 
in jiarpncbymatfi with which thtwe |i(irt«aru luon; or less coiiiuvtwl (hings — 
cxjtecior«tion). W'lion fuiiud upon fme fiiurfaces mid in.»t. t^io f>*flily d*'vnl- 
o|ivd. thf;y |tr(.rs«rnt to thf* lutkoil vyv hu ap[x'araucc n.'HfiiiMiiij^ inuaUl : tliey 
form now sUitrply dffinetl, circiimttcribed s]tc>tH, now nu irrcgidtir mnrc diffuse 
OQVenng of a dirty greenish grey color. When the mould happens iipou 
the hmIh, bt^fom or whur pivviouti tipliltiiig of the body, a thirkiruiug 
up|M!nrK, and u ycllowuih difiuolomtion Hhiuiug tiii-uiigh fiuni ben4>ath, which 
Bouifliiiieii occupies the whole length of the nail, nometimes unly it» anterior, 
ami lut«r&l portiouH. 

CoBsnlt the oollcctlomi of Heitsinokr (Her. d. TFflraA, ei»t-. An»t,, Iflflfl) And Vm- 
CMow (Are/i., IX, p. ^1}. Since then nnmeroug lanlatc^ obwrrjitinns of MVK^wia 
oconiTtnjf in »evt!rnl IfK'nHtiea havo been jmldishcd : most rolul^ to the oxtcnial 
orgnnfl of b(!arinf!. iCkamkk. Maykii. 8ciiwart-'.k, STi:.fDKSKii. Whkiikn.) tuid 
the longs (Viritiow, Fiukdkriiii. Dr^cn, i.'<iirN'llKlM. >— I'urtkularly nuim.rou» ute 
th« <su(» of muuld fortniitioii within the henliliy iw Wfll im dicRnimd air-iias«oy<w 
■nd air-ohamben f)f thR 1)0114^ of tjinltn. V\*i>u the mucoiiH mfmlinnc nf tlic. nir- 
paAsagea, thU fnrmnttnti in Minictimpn no netivo Ihat tho entrauoc of t^e nir into tb« 
loDjr* i" hiniloreil (lTt.i:oE, and oth«n). 

SAi.rsitcnr iSrAm. Jb. CXXL, p. 4iii raw among thrRiheni, and in military oauips, 
an outbreak n^>«[nhliiig- niennlf-s raiuud by fmiguR snores from RLmw. {Aoi. Jour, 
o/Mfil. Sri.. I^'ta, II.. p. 17. p. 387.1 

PBrhtipu here alw) belong the Bo-tinlled Mai>uua-fodt (Hikm'u) or MvcirrnMA 
(CiK'ntK), of n-bofte funjnu v«rj- Ultlo is yd known. In wolatod districU in the 
BaHt ludie* the uumplamt it eii>1cmiu. fNV-nrriiit; pr^ffmbly on thit futiL, and uhuhcti, 
ha the altnukci] i«art, cotmiiJeniblc d'lfonnity and dull iwun. The funpnw j:roWB firnt 
in the ffubentnncaiiH c«IlnLir liswoR, which thwreliy nnd in coneequencc of llie inllarii* 
mat-ory inflltmUon ix greatly thirkcned. TVc the nio»t part only after several yi-ars* 
diiration. warty nodcR ori(»r. which tiecomc jKirfgraU;d and emit a thin, ^ellowiah, 
stinkiiti: ht)ind with numerous little black mojuca. wbich <:4intuin anmiijjruthur tbiii}fii, 
fuapn" Ulniiieiitjt and Hpored, The uker nnM-ifyn tlmm^h tbu :'(ift parto to tins Wn««. 
IV'uth tTMilLs fur the raoMt |>art from iituroAinas. iCon«nlt the descriptions, Gll,l* 
■nd A. V. 0\BTER, BiDlB and the colleetions of cases by Illl{t«ni In VircA. AreA. 
XXVII.. p. 'JK.l 

Id mauy caaet. disordcm of the digestive npp.imt.ua have )>eKii observed after the 
nac of moukly bread and fixuiuige. Witli rei4[)e<;t to thix, indeed, it rnniaiiift quA»- 
tkiuabte. whoth4»r inoidd fiing-i or the »ihpmical chnngeR nf (he foml are tlm rautie 
of tjie afft^tioii (HrsKNUN.N. //</A. rf. T"rifn(/yif, lSri2. Snppl. U:*07. i. Musi.kk 
f l^rcM. itrrJt. mis. XLIIl.. p. I'ili ftaw inlliLmmatiou of thn nntt^ouH luuiulirano of 
the stoauich QfiiM tbrouf^h the UMe of blue milk (the blue color wn>i due Co fito-^'i). 



n. TbB FUVOI op the TRtTfi PARASITIC DIRRASES OP TKR SKtN AND 
MLU-OrS MKMBKAXRB. 

The piimsitcii undrr consideration como passively upon or u-ithin the 
body. Thoy reach the outer siirfiwe through the nir, or by direct or indirect 
contnct (clothes, beilding, combs, razori*, etc.). The inf'H'tiou is coni- 
nitintcated souietimeg from man tu man, Hometiuus from domestic ani- 
roalR to man ; e.specially often does the latter occur in the jmrasitic forms 
nf her(WB. These pnrnsitiea happen upon th« niwcou.1 nicnibraiies or 
within the Ixwly, **veM in the lyniidi and bbod-vessela, through immcdiatt) 
ac»;idfutal traiiHport«tiou (*;.,'/., in cathetei-ization), or through the air 
which we iuh&lUj or with the food. 



'96 



GBKHK^L EFFECT6 OF FUTiCT. 



The fungi imlicAtc no speoinl prc^cUHposition on the part of tlieir l>earer 
ThcT grow ami iiicrf-Ase oa well |irobftbtr ujion Uie heiilthy as upou tlic Kick. 
Moisture mill warini)i ((latnji ilwcIlingK, moist |>oulticeaj wiwHm under- 
ganiienU), ur<; [wirticularly frtVumble. 

TIk' Kh^I itwiatliirfi iff the »kiii arid of the macotm niembmiics, piirtiiruUrl)- 
thooe ]>i-ovidL*J with luminaUK) opitheljimi, have until now biM-'u idinoNt the 
only ones fully known. Whether fungi attack the altogether normal 
]>urtJous of the skia ami mucous meinbrAne, ami there develo]*, is still in 
iliitpute: usually indeed it is the jiortiona of skin which wciv kcpi It-n 
oleun, and of mucous nicmbrano of the same kind, or such as had sudered 
impaired function* or whure previnu&ly atuall erosions had existed. From 
KQcth plactfK, then, tha fungoua growth sproadK about u^>ou the surrounding 
normal iilnn:tiir«?s. Tlit- tilaiiieiilii and .sport* grow and incrca.se pn'ferably 
bciwir«!n the rpitholml ceHa (with most ditlJcuUy between those of the np{»er 
layer, — most easily between those of the middle layer), lx.'tweeu which 
arise the hair and iiailii, caiiHtng them to becrmie lontM?, and eiriTting their 
atittpliy and tiual destruction or falitu;; otF. In this formation pus does 
not usually appear; but tiierD exists for tliu moat part a marked Iiy{>cr- 
lemia. GroMrtb takes place partly on the surface^ often so that larger 
or amaller 8har{>ly dofine<i gr(ju|iK arise, partly beneath the surface, wilh 
or vithout the aid of tin: glaudducts of tJie hair, and the hiur-folUelea. In 
the deejHist opitheliiil layers, on the :iurfacc of the fibrous tissue of the skin 
and mucous membrane, the growth of the fungi usually ends. Rai*e1y do 
they grow between ilie tibtvs and pass into the vCMsels of the lymphatic and 
vascular aystems, 

Tha conao<|uenco of the presence of the fnngi referred to are : 

Irritation or the sessoky nkkves, which results, partly perhaps in a. 
direct manner froni the prwienct! nf the fnngi, between the epitlielial celklf 
but in gtt»Ht i«irt from hyi^ei-a-Diia, which the foreign bodies maintain by 
their spi-i-nding jtml i^rowth. Titus arises tlio not inl'mpient violent ifchiug 
itx fji(i/ria»i.* rcrxiVvj/or, and the burning sensation of the mucous membrane 
of the mouth in thnish. 

If the fung*)iis deposit is considerabW, it gives rise like other foreign 
hodies to inki-^msiatory ittniT.4TioN, which leads to erosion and uleuratiuD 
(|iarticularly the favus ami thrush fungi). Thereby the neighboring lym- 
]thHii(> glands may beconm swollen. 

Hy the pretwni'e of the fuiigttus iiia«»eR, the subjacent skin undergoes 
ATHopriv, by their growth into the hiiii^follides ami hair, dcHtniction and 
Gulling ofi* of the hair follows, as in hrrpen tnintnrauM and in favux. 

When tlie quantity of fnugi is large, they cause, in addition to the 

CTHEMICAL DEirOMPOSITIOS OF THE CONTENTS OF THE CAVITIES which they in- 
habit, swelling, r. (/., as the thru>>h of the oval cavity. In (his manner^ 
new irritstions can arise, whicli lead to convulsive nuiflcular niureniitutS| 
vomiting, eructations, or to catmthal secretion, to diiirrho?a, etc 

Only by enormous growths of fungi do STiturrniE and rLositux or 
cn.Ut'NBLs occur, such aa, iiiost rarely, of tho lesoplnigits, and the great air* 
imstuiges by the thrnHh-fungus, 

In rare cases, where the fungi penetrate the bloodvessels, local nraoKDO- 
8E8, OK KMBOLK' UAsKES of the fuugiis itself cuu porbap:! occur with the 
usual coDseipieuces. ( Yide infra.) 

PifBt of all. Sen "sr.KiS In IflW, for favus, and soon after J. Vimi:i.. for tUnuh, 
famiehed exact pvoof that funifi wore the c-auw of local Oicease of tlio lOcin. Very 
qaickly then were fungi dlsuovcrod to be the eausea of ubLur di^casvK of tbu akla 
Bod mucous oicnibraues. 



r>PIIYTO» 



Wlule Uio n^ltolo^icat Bii^iificntion of thef« fungi li.-vs thns heen determined, it bas, 
in la.ter yt^aiv, on that account efiiMK'iftllj-. l>ecn questioned wliothtit the difToreut 
fongi trnljr heloag to different siweics, and wbotbsr most of Ibum do not bviung to 
the Bamo mnnld-ftuipiui. (T. Fox, Ualliek.) 

Thf* fangi to be studm] in tliiH coniiectiun are: 

Thicophyton TQSiBtRASs (Gbi.:dy). Tliis cousists of round, tmiiKjianMit, 
large (1),0-I4 — 0,01 mm.) spoils or Bporc-rowa. Tlit-'v Ucvi^lop in tJin i-oi.it« 
of the liiiir Hinl puHH hoiice iiilo the »liuft uf ibe liuir, ho tliiit tho Ititur is 
entirely dcstroyfil jiiid l)CPftk« off; likewise in th« sheHtli of tho hair-roota, 

' siirroimJiiig epiiJcriuis, seldoni in the nnila. Thi» is tho idwun of the 
Sciinvnce, t^jiecially upon tlie scalp, and moT« rsiLdy on olht»r |iaitB of thu 
skin, uf /ic'7>r« lonsnrirng (riiigwornij porriffo scittjllata^ tfif/ne h/nUanU, 
j»ht/to^lo/t'riti) ; also of tlif piirasitio forms ticeurriiig upon the Ucurd, irtf li- 
ra or tfj/coiriti, of ecsema tnarffinatum / likrwiHe, tlnnlly, of tuauy forms 

AoooTSmg to HAX.MEK {OCihrunjiMrtcfu , 18091, the tridiophjtoa proeeeda from 
antwT^ltu. yKL'MA^^ conHrniA IltitiMV opiuiou fouodud ou dinical obsttn-ntion, 
that h(^q>e6 tonsuroiis oiid faviia ciui ari^e b^ uuu fiitiguM, iind iudond, occordini; to 
Nkhmaks. fcoia pfiii'-iHiutn, iu >*itit'l« caites nlK<) from trirh/>thfHit7n. In AVvtw* 
l-SeA ('"l^'i:. Vvrr. •[{(.. 1S71. I, p. 4.*i| (ixixTiiin'iitR in cullivfttioii with mycolia from 
heqt«t< t-n»«irarw ntid favtiw, tht're wcro dfrvoJopcd. ftftwr tlirco months*, uumei-oiitt 
Inut form.-) of itJiitrrgiUHt, for thf moAt, part of tbc lunal appearuuco, iti part al»o with 
fclann^ntoiis jfitatly eb-ngat^d bacidiann. 

AcconJiujr cci (iKHl.ACtl. an afFtu;tion Himilar to hpr|)eB tonniininh octinra in ontllu 
iDU FUrhtr tUjt Itiuittjt, I8ri7t nod in dujpi (.l/*i^. /. ThirrheiUk, !K*j!)). and nccording 
bftSTKiN il*rmj. Vjnc r., It«i0), and BOiknhfiius'i d. c.)an affection rainilar to h. 
ciroinatnii occani in oata. UAitKNttfitUffii (I. c. p. l:il> furui>ihntt a number of oxam- 
I ID whivb h«r|n,ii circiiinlitii aud lopMinuii* were traced b»i:k to au iiifecLiou ema- 

itic^ f roiii duiiit.-»iii: aniuialit (eattb:, hunu». dtigti, catitt. OI'Tk. FkazBK. Tl'CK- 

Rl.r, a:id otb<-iH, bav« uiadt: Mmilnr olwcrvatioiw. 

In itiuirEtt TosHUK.\N* of ibo scalp, there appear one or more round bald spota of 
Tanrinip eif^. where the hair iK entirely abaenl or broken off near tbo anzfaca, ood 
witJioiit hisirv and vUbtioity. Aocordlu^' to Xepmakn it .it>pcant : 

It.) Af4 A. tout. reaieHlfauii : itinaU puuctiforni vinickfl with dear contents, 
arr»ng<^l in »:ir«ular fiirm. nhiuh allitr a fow hour* dry, leaving behind imatl thin 
acnli-n aiiil cni>it.> Immofliati'ly nfl^r new TitRirles ari«o with aimilar destiny, and 
ihuA pfriphorically tht? diwu^p nirrea^en in extnnt. 

(9. ) A. /otu. HuieuUttiUM foru^ pale rcdtiittb spots, in tbu centre uf whiuli is a fili^ht 
whitiiib Miiirf ; thry «prtad pcriphcrically, wliile tbu cwntru groua paie, thereby 
firing rikx to ■ form n( n-ythnnn tiiintibtrif. 

(3.) A. fiiim. «f ifdtiioiMii, a luttir nui(;e uf the two formii naxaed obnre. 

T! Ltf MtiNTAuitA. OT t-viuj-is wn« fumicHy held to be a Rpcciol form of 

fu; - >tffu*}<irot iiirHt>iijri-jti4titiif I'ltoniN), Ther*: nri!, howovrr, OfJCiirdiiig to 

Kim.--- .. , fu.-h. Affh. XVII,. ]i. i\7Z) and ZlKM.ssK:. (Oreifur. ftrUr. H.. p. VOf. 
twn ftjnn* of raeDtagm, one piir>'lj inllninmatory yf-^icuUtin htirhir), the oLhcc 
parasitic Thu fan^e uf tho latter is identical with that of herpen touftumUH. Thie 
iK proven by the form, «i«e, and pcopajcation of the fongi, ao that hcjrpt's UiitHurau8 
can t>c i^fnierated upon (ho nkin of the same or of ouotbt-riudividnul by mcann of the 
cruau i>f Kyoosia, and in torn the crast* of h. tons, can give n»c npou a heidthy b(»anl 
to a t<yccM>. Tb« fuoguti. in -lytrLwiH, h d«v«lop«Hl between the hair and root bbcath, 
gTDw-a frfim tHtnoatb t<t the Itioacned hair and cnuwet! its atrophy, while the tiftHueH 
anrroundint; tbt' hair fiillirlc dcgi'iirrate into a coudyloiuiiU>Ur< swcUtug (papillary 
^yjuDniT.'ir i That the fungiu can«e» more marked appoarauc«is iu the akin of the 
I titt.- valp, is accounted for by the mnr« coaNiilerabb^ niztt and dt^t-per 
r of UiH linJr-fulliclB-t, and by the tliickntHivi of the cohum and aiibcn- 
taticoiit t:i U;kl.'\r tiiwtio rich in glandx and vcHttttla. 

The M Kt>Li MAKDLNATi M of llKKitA. wbich IS charactcriicd by its couatani 
locolizatiuD OD the inner t^urface of tbc thij^'h:<9, on the niona vooeria, and on the akin 
of the m:oI. muuh moruAcliloniuu otlx-r pnrt« (in tbr bc^nnni^ appearing aj* tar^e, rtil, 
raiMHl ■|Mtt^), liy iu* iM'.riplK-n»l lulvaiiut* »tid (Iinlllltaui^utlB iuYuhitioii iu the wntre, by 
thu uukrited limit of th« periphery iu the form of a nuned bro^miah-red border, upon 



ACIIOniOX SCIirEXLElXn. 



which f)(!nlc!t, papiilr^, and ptii>tiilef(, later mime'. [ineKiUMtoraxts. arc ofl«ti found, wrrll 
Ml by itfl almost exchmivi! occittranoe in man, nnd fwiwriailj in shoemaker", u*, aa.>«>nl- 
inp to KiBNKR, dependenr, u|K>n trir.WfJtftUm i'tnmramt (or micrr«/-jAw j'urftr, 
NtT-'MA.KN.) Thiu ia sitofvii hy tbu warso of thu duMHiao, knowleilxe of ibc lumuil*, 
and eKperimeut. Aoconiing to Necmann. tbo funjcua elcmoutd in tcccma mar- 
gioatum grow by cultivatiou into fftiicUUittn gl'ttutum, or into trif^totfifi'-itti la 
otb^r caMBH «f:2. tmtrff. on;riRat4tH In an already jmtfannHd ret. intrrtriffo, no Uiat tb« 
fun^ tH*longHng to thu lutt^ir grovt on Imtwctm the cutU nf the ejiidvrmiB and then 
roodify the form of the proiwij,'atiou of rhe eczema IXkumasN). 

0.\TriioMV4'«>^i$. in which oue or mora nuili appear toonened an>i tbickcocd, and 
havo a dlrty-yallow culur, au uuL-vcn, fiuarad nurFace, and an eaailj split, U iu man; 
rauHM due to triehajikyton toMurnna. 



i 



AOHORIO.V 8flI(£M.B(Mi: FAVUS KUNGUS. 

'X'liff luyceliiitu consists of ttirnple, or limnctied, cylindrical, curved fila- 
ments, whii'h ui-e eiT-lifr ai'ticiilutvti or diviijcil by |iartitioii walls. Of those 
are foinifd tin- lon^r, bi-ojuler, tilaiiieutoim i-t>c(^[>tMCula, which are aiiiciilato 
and cotiUun rows of sporea. The sport's hiv round or oval ; send forth sin* 
gle or nianin^ld shoot*, anil form joinli'd wnitw of Hliunvntis, nut of wliich I 
t\w. iiiyucltnni is drvdoppil. Bt'sirlfS, min-OL'occus coutiuiuilly a[iiicHrs. It J 
is fonuti iu the deeper layt-rs of the opidi^iniis, lHt<>r, also, in thtf hlit-aths of j 
tho hair-rootB, and in tlic shafts of the hair thoinaelves, alihong}) only | 
betweyu the cells. The aizy of the scabs ia 1-10 [~]) niut, their ihickniH* i 
1-6 mm., sculcllatc, yellow or browiiish from dirt, ury and brittle, and they I 
oonaiat of an outer umoqilious tinoly -granular mass, and an inner prr>|KT fun- 
giiK-inat«. The lutter shows i-spHcially upon ita exterior the mycelium, io 
tho interior follow the rec-J^ptiiculH, innermost are the B|Mn-e8. 

This is the eaiiwc of F.\Vf« {tinra or jh^rriffo tupinttnt^ tinea ^nrota) 
Mpoeiiilly on the sealp, more s>*l(loni on other ])arts of tho body, cxtnmioly , 
rare on the whole body ; and of most forni.s of oDychomycoisi&. 

Zandsr flaw favtu also in cats and mice. 

Those affected with favua incur the nail-Fungus by Kratohmg (KraTTSB, RrrPtNO, ] 

B. WAiiXRH. and ntben]. ' 

Accordiuf to n^t.i.lKtt (I. fi.). Stark (Jni. Zt*ehr., 11.. p . 920) and Pick ( Vntrr- I 
$veh, ub. it. jifiil JJifntjvtrauf-fn, ISflS). epeclsl experiments l>y inoonbilioii with fitruM^ 
fierj'tx. mid pe.-kiVin'i, (or n-^tfrgiBtfi all yiebl a similar rcault : (1 1 iu opidenual in- i 
OcnUtton of favna tiirigus, a hnqjetic ertiptiion generally pn^ofldfw lh« d(!vcli>pm»tnl i 
of thp f:ivHS crustw (initiative hurpptie Rt-i^Rof KiiBNER>; (2) thw paHMm on Ui/'Ifh*, 
or to hrrj>€« tonnunint ; (U) inoeolation with fung-i from ^tfrjt. loiui. (feneraUy yielda ■ 
ft^D only hfrp. toixM., sometimes, howcrer, a form of diseaaea b develofietl which 
is ideoticnl viitb the herjtetic initiative stsj^ of favuft. and being abortive paMe* 
away ; l4 after a Inny dumtinn nf the favus. in c,v<<?» of more Inxuritius vf^t«tiaa, , 
organs of fruotiflcation ai'»j>ear, which beb^ii); to tho jtftiie- fff'inc. and to a form of 
lUpergSl'tA ; loi inocuUtiou with pf/iir. iiiii'ic. \>\i the skin of nian f^ves rim lo a dis- 
ease identicaJ with initiative herpetic ettagc ot f'Uun ; {iS) thus, one cmd the same 
fnagrna gives rUc at one time tofupttn, at another time to A*r/». to/ts. ; l7t thi» (nn- , 
gns doM not occur Rx:;ln.<iivcly !n dtMinsiw of Vse skin, but belongs in natoiu ia a 
vftiT widespread spHcie,- of fnugns. — Sthi'MK, KiIknkr (1. c) and others, oli*ftrved 
that herp. tmu. always (fi^e rise by inocnlations only to ht-rjK tann. and Uint only 
fneta always aro** by inocnlation with /■< run. The herpetic initiative stage of /**r*tM 
u, accordiuff to K., indeed himilnr to hryi. Uma.. but nnt the tumiu. 

Aocordinffto KiNDKI.Kisfn {Virdt, Arch., LIV.. p. lO-iilhe identification of »tiA"r. 
Seh. with jtrnirHIt'/m, mtiirrgiViii, etc. is preniature; mthnr achorion Ifolon^ to a 
place intcTinediate iM-tuFeea yesja-fungnn and thn>ad-fnngus. where arUinilat*! ftla- 
monta and higher di0ureoce9 with renpeot to fruit-formation are oppowd. 

MicROBi'ORos Arnorix) fGRrnv). 

C(.'n»tPt« of nndnlatinff forkod flhmonts upon which small spores are direet]jr| 
placed- Fonnd around tho tihiift of the hair, after its exit from thf follicl*', in i 
ao thick Omt the hair breaks oEt for the moat part at that place and muses baldaen* 



Jim^i^ 



99 
•eooMittpi to Onrnv, Baxiv, IfEintA. tlie cAnse of ponnioo drcalvana 

ittrvn f'dm a. aittfvein eArettm»rri]>fn\. whil^ ncennhrfr to Ml TClllNWiS. B\1{HK- 
rruvvn, TUK Atrrirnu. RiNDKLEi^ir. Kuiin. chu affection U not ptumiitio. bul o( s 
avToiu Datum riVf^ iufm. 

«ic«i»**p<m'>!» uwirTt««Mi."M (nirnonARnT and n^nKXfpRmo.) 

U ■limtiiigniAbo'l Uy t'lc «pecinl d'^Iicacv of it« cl'»rat.'iir«. It i» the cnuse <.f n 

litultnl P))Dhig'iijU3 nffeutjijii, for tlie iiii>«t part iiim>q tbe iuj^iiini. or nxiUnrj- m^otw. 

til* •o-called KltTTiniASMA, wliioh liku tliu tiitfffin»iM rubra ny^iesa* m Ihe form of 

rmuMled or roeotte-Uku, red, ■bai'ply defined Axy epoU KAKMut mu- neverai snch 

MlLltOflPORON PURFL'R (RODIK). 

Couhifita of masses i»f lurjft' (n/tOr) rniii.) ronml, riio«tlv nticletitcd spores 
uufl lyiigt.beiieti or brHiiflit'il wUk, utii] cuily Kmuftiiinrji of vhi-v innrirnniH 
Vjroittl ((',004 mm.) tilamouts. The sporcH sliine, have a sliai'ii (IouIjIh 
coutour and foiTu <lenso olii8tei'<etl gr<)uj>». It is doveloped in riio liuruv 
ImyiT ijf i[iv eiiiiU'riiiiR. I'oiiiiiHinty urniiiKJ thi? i>pi*iiirig uf t.li«> Imir-fiillifles, 
c>s|i*-oiHMy ii{Kju the bi-puKt aiirl Imok, never on llie fit^ely ex|ioH^t] ptivis of 
tlic Inniy, nor on oliildren. It cftiises yellowish or i*e<liliah-yeIIow, spotUKl 
discoturatioii of tlnr skin, the spots ct)Vyi-<;J with brnu Ukc» 8fMlt'>«, mid Kome- 
timejt violeni itching— it is tins muse of pitvbubis vekbicOlor, or (*hix>a8Ua. 

AcoinlUi^ to Paplixi and Oamhkrini. a fnu^s similar to that of farwi and 
"^riiiMM rmkUnr \n nlmi foutwi iti u;tJi.vohU. 

lniwn,T\ CAPILLont'M (MMtTiN nnd U«ftIL>. — Agrees oinnUy with tliu forniB of 
piilmtHn. C"OMn{m of a "ttrtK'lnti'liwJi. ji-lly-like hiuiH>Mili<njuicc in which very )*idiU1 
ctlln. niinlo;fouj» t^i th« jcaft fmit'i. «m cmbCThlt-d. It ciihirs thr hair, flmt vtllow, 
/ellywisbrod, bl.»i«l-n?d. hrow-Dihli-rcd. flimlly bniivn nnd <.*vrn hlitck. It i» Hltnnted 
iiiMler the uxUrcu^l lnyer of ibe hair. \Zuchr. f. nit. Mai ISW, X.[V.) 



otDiuM Ai.BirASs (Konis) : Tnnrsn-Fi:Noi:s. 

ConMsu of cylirniricii,l, Inimched, t'urvol, .Mroiigly rffmoiing, sometimes 
Ruclied (trtt* slmped) Ji!uni('nti*, which iim cutnpoMed of long colls con- 
together, liftwt^ttD which ronHtri<'tions ur*' oft^n fomul, Ertch of the 
long cf-lU njiiiaiuH many j^'iAnulos. Tliu pn<)» i>f thi* tilanH-ntH aru loHt in 
niwutcH of Bpf'ies, with a lui-gf, often divided Bpore-cell. The fi*oe end is 
siinpl*% roundetl, or terniiimtes in one or Revprul Jnrmi oval 8(>ores cf>nnected 
together. The latt^-r ans nmiid or tival, ofl^-n uiiit*s| In nnp ai)Otht>r, con- 
tain grjundea and eonstitutt? Ui-^^; niniwes upon the epithelinm. It is 
often fuund, and KOiuetiiiies in latj^e mas.'tes, in niu-sitig children, esipi'cially 
witltLU the first weeks of life, «» well as in adults alTected with wwit- 
ing diseases (typhoid fever, tiiherotilobiH, e<e.) : npon the mnonuH nietnhrnne 
of the mouth and thr<mt, Sfldnni nj*on that of the tiwophagiis^ n<»se, large 
air [■iiSS'tgeft, hings; Kchlom ufxm the labia, bre-ost and lips of infants. It 
utrourti in iiifnuts eH]>eciiiIly tlirongh xmnt of cleanly attitntion to uursing- 
bottleR. and in warm weather. It repnwents the so-oalled thruKh, aphtha'. 
Tlie aphtha^ of (he n<*w-boru form grayi».b or y«'llowisb white i-oond spota 
of the size of A pjii-luiid or letilil. i'spiviidly u|)on the boxnidary hetween 
the hard and aoft [lalateH. They griuliially enlarge, unite uiul ulcerate. 
The aphth;*! nf ndullb are gitiiiitiMl es|)ooially on the mucous membrane of 
the lipH and chiH-ks jinil on the end of the tonjfue. 

Afttmling to Dt*ni"»\Itnr iChnr. Ann .XW.-?. 1) the fniit-eaiwnlex of the thmsfa- 
f„,.,„„ — .....t .....,n.i ..P ,.,■/,( flnmeiimiii doiihle-contoiir capiiuleii. ,02 to .(Kl m?n. in 
f7 lilli uporrtt. and bnmi very easily. B. eotUd notdi«oover 

en- I I . -iilm and libuncnlA. 

InoppuMium to WuiciLKb (,«. p. 1)3} aud in uccerdauoe with nACSMAKS {Jttri, oud. 



100 



FCKOI OF FmMFKTATION AND PTTRKFACTrOS. 



CirfjL IdQO), dio fuQ{fti8 occurrjiu; on the female gCDitAlH U i^t^otical with cWftVmt 
oihif.aun. It in Hke tlm lAi:t«r, traju^miiuiiblc. AIao the pure thrmh-funfftu of the 
month is tnuisTniasihlc to the va^rmal iiiticoiDn uieinbrAQC SowingJi with pruif. 
fflftiur»m, iiHffery. ybtiictm, th« fungiift of jnljftittau trnnffitir/r, wam uLtendcil iritli 
nc^ativD rcsulto. 

Koirx (.SVr^. d. (Jcm. d. Witn. Aen'.f, SO Mai. 1871) found in man; ca»e(t of rcuriM 
iinprtigiutmnin fiirut (trnjirtiffo mntitgiwift of others) fihMiitJutou* fiiUKV ouco alvo tbdr 
oiigaiu of frueU Haiti uu. It is (•till (jumttloiuUiIc whether in htrfif* irit aod drct/mttiM, 
M weU M ta er^u./mi 'WiU\/'"rtnf, faogt are nraoilial or accitlejital. 

iiiFLOfirtmivu Ft'sccu (iuli.igr). 

Sometimes on diphiheritio membranes of the throst. Consiils of extT*inelr ' 
delicate. ncaXj nmt im!giilarl<r raintlied urtieulatvd filameutA. Tha lun^ estenilcd 
bnincIiiMi are, with iiuitu nj^ular ulterualion. eovi-red with Hhiwt. pcriJi-mliciilar latcr&l 
hnuicht's. The hranchcji Mcldom remain v>;(ri*tativo; for the ino»it jiart they very 
iKKtn fihnir at the end a stnnJl f'llliculoiis nwelUn^, which very qniclcly r-nhii^ep and 
indcHned fiora the extremity of tlieir hearers as oral, donbln contour itporM. Tha 
«por«8 oasunie at tha time of ihf^ maluratiou, a bright browu color. 

III. SVSm AS EXCITKBS OF FEaMKNTATIOK ASU PUTREKACTION, AXV A* 
CAUSES OV HONTAUIOUS AND OTUEK DISEASES. 

The mould aud yeast fungi, in rare cases aI»o a fvvr other fnii^i, whicli 
lmvi» ftlii'ftdy bwn mentiiiued, prolmlily alsw) a few other not well known. 
h«ve, Iwsidcs »i IochI, h very imjturtant geneml KigtiificHiicH. This rlppendi* 
ii|>on the fact, that their geriiiit, everywheit* jtn'flHiit iu the air, are jh-oIk 
ahly \hv inoiit vjwiMitiuI cjiiise of the variuii» fKniiuntiitions t^ilctiig place witli- 
ont and witliin tho organism, as well as of the imtt-cfaetiou of orgnuic 
bodies. In both pivccfwes tho exti-aoidiiinrily active vegetative fungi take 
lip HH nourislitnoiu foiinnd elements out of ihu iiffected siibatnitum., Miid »o 
du(.*om[K)Ke the stibKtratnm it-self. 

That fmij^i an; the cause of aevernl, more or less spccilic feruientiuions 
(awtic, aleoliolic, laciic, butyric, Ac.) is vnry prolmbli'. Fenueiitalion i» 
that prcnliar prucetui of decrun position whidi or^uiic l>odiett, fKpuciHlly 
IhoMt' nun-nitrot;eiicni8, auffor when llioy come iu contact with a ft'nurnt or 
witli organisms artinji; im ft>rnicnt (f. jy. the decoiii position of KUi;ar into 
aloohol and carbonic ucid by yewtt). Albo, for tho appcaiiuice of fermeutit- 
tion there must be a pi-opor temperature, vrater, Aud, for the most jmrt, iio 
cess of atmottjdicric air. 

The importance and speei0c nature of fiiiigf for fermentAUoii hna he«n especially 
shown through the works of pAsiKtm. According' to LrKiiio and recently itttiTR- 
BKYt.l'tii, ft*riucut»t)un doux not ilu]HTnd upon fuu^is, but is pnrely ehamicnl. n procoM , 
dep«ndent upon frCHoalled contact -sulMtitnoeii. [Mfft.-Cftcm. vnUr*., l."^71, 4 H-, 
p. 501.) 

TlioRO fi^nnentivlionH are of palb'>Iogical intA'rest which lake place iu Uie 
orgiiuism, and piuticularly in those cuvitiea which are provided witli a niu- 
O0U8 nieinbrani; (istomach, bladder, etc.). The oi-ganisnift which excitf fer- 
inentution (ycast-fungns, mould-fiuigns, often alw vibrios anil ltACt»-ria) are 
iutrodnceil cnsually, by the foml and drink, and bv tueatis of niu*U>»n iiifrt.ru- 
mcuts (catheter) into the inteiior of the bmly, Tliey sometimrrs caudc slight 
iriit-Htioui, nometiuieN inHaunnatton of the afFcct«d niucouK nu'mbi'aiie nud 
rtf the i*aryuchynmt<)uw organs connected therewith, c. ff., tho kidneyx. Th£» 
is ihw partly to the iuerease of the fungi, partly to svvjrtn-sporc6, also indi- 
ix*ctly, ircrh&]>rt, to the chemical chnugoa induced by iboiu. 

Wlietbrr the yeMt.fnn^'nii and the fmrdna-rrnigtiii eiert on injnrions [naneBon 
npou the uiuoouH ratimlirane affected, is not yet detcnniued lr«/c infm}. 



rCNGI or FKltMENTAIlO.X AND ITTKKFAfTIO.V. 101 

Vfl^flftBlT'. however, witli respect to harteria iinil mflnM-fuiipi %vhicli find nn pd- 
tfUMSlMtt Uio lilibMer by tneanft of imcloAn cjithet'frn, »l)(nLinc fcntif^titnii'm of th« 
VrilM tnny on.'ur witli couae^iuent »u-uailud |<arasitiu u^biitU. iiycUtiu aiul DCifbritix 
(Th'lIbk. H.-rL ktin. Wo(AemKfir.. ItWl, No. '*•>. Buc uiiw Kleu5, Udb. rf. jwif*. 
.4/i.'f.. is70. I . p. Km. 

The fungus -forrantion* objerred on tho nrncooR membrane of (he month ond int«B- 
thwl oauol have soiiiettmee onlv o local importanoe, Kr>nicttmp« tboy t*ivr ri)w to 
Mvere ami fatal maJaUtw Barteria iu tlic mcmtb, on thr looih. stimnlato the nitro- 
g«nnufl rumoiiis of fwxl to ptiitufactive furiiiL'iiUiLioii, atid produce lactic scJd from 
nifptr — tlifjt nre Uit.' imnicdinCe fnnHC of ttmnnon taritw mw p !I4)- Tli« tlirufili- 
Aingn* givps rini) nHimlly onljr U» n light loRnl dismvltir of thn onil cjivity (sw? p. W). 
This \k however, nwt iilwiiys m). Zai.kkkv { Virch. Arch.. XXXI., p. I'-'t!). siiw 
thnuih aX*o in m&iiy upoUi in the Htomnch and fonnll intf-istincii ; the child had bud 
Tit>t<-nt voiniUu;,'x. laliir rUo diarrhmi. 1 iJaJtrb. i. Kindr^rhlk., l»6y. 1., p. ftB) miw 
au fxtcnxjoii nt tbis fim^ns inui tht; Inniinn of vt^Httln of thn mutxHu* iiiiimlinuio 
of tb« tutophngnii. Zi;ski-;r {Jnfirfain'.r. it, qm. f. Xut'tr- w, Uriik, in DrfiuUu, 
l(«;i fi'i) found in on cxu-iided oncopbulitis, numf-roiis omnll fthsrply ciK-umacribed 
|H>tiiLM tif jiciH. whieb cuuld bt! lif u.d up with a uced]'.'. uiid nudt.'r the niicroecope 
fkfcuwn tti be Uttlt: iiiaxN<*'« of fuii^'iiti lilaiilciiU ciivelojM^d in a tliiu Inyer uf puti. TllD 
maraus m^rnhrane of tho tongiip and thmnt woh covered with maivrOH of thruab. 

As Hayfkvkr viuitloNKi*, HkimiimLTK (FtiNZ, Vireh. Air/i., XLVL, p. lOOjJe- 
Bcnbe* httlo vibrio-shapod botlkw, which »re yxpcUod in an attui^k of hay-fe^or tmly 
duritii? tioU'nt Knceting. Tho usually isoltitcd Rin^lu artjculalionit nro U,ih)4 mm lonff 
and c<>iitaifi four ^TnnuItM in a ruw. wliiob are nifnin clonely uuilcd iu italre. Tbey 
tnoTH upon the ^rarm nhjr-ct-pluta [uirtJy with a ti«mbliD|[ motion, }iAnJy by darting 
forward uod backward. 

Fiirtbei'inore, fungi are the caiiRcs of Jocdv an well as of |mtTofaclion of 
orgKuic, especuUty nitiogenuus bo<Iif.-H : in the latter, reduction, iu ibe 
fonner, oxidatjon tukcs j)1aoc. Iu both |n'oci'B«ea tha cuiTe»p4tU(liiig fungi 
occur: in tin* furnitr, tht^ ko-ciiII*^<1 aiiiiero[iliytea, which do not uefd tlip 
clirvct influences uf thy nir (vihnos) ; in the latter, iiti-ophytfa : mnundH 
Mild hact4*ria. Iu decay tin uctive gxidfttiuu goes on undur the infUiench 
of U»e fungi, whosy ['ruducts aru wiiur, carbonic tioid, nuiinonta mid 
ovgstuic cuuifxjutuls, tiiuio siuiidc tliiin t.lir>be- whicli wi>iv nriginuUy present. 
Tht: fjjreatest part of the orguiitc iHxIics is thus destroyed, so ilmt only ii 
cou)|i(Lrnttvi^ly snuill quantitv in uiken up by the fuugus as iiGuriKlinicnt, 
III ibe t>auie subHirutuiu tiiu process of decuui[HMiitiuii dilTcrs with tim 
ftiiigiw jirewnt, I>eeny i« HrrcsttHl, evfii at a leitiperiiturc Kuitablo for 
dtfcoiupo^iitton, if t4ie lK)die» nttiu-koti ait pi'otectuil from tho access of 
fuiiiuruB gtTins. PutrefiiPtimi, necnrdiiig to inorB recent inveHtigatibuK. is in 
tht* JHiinc uinuner depentlent upon bBcteria. as the VHiioiis fernieiitatioiiti of 
nou-nitrogcnoua bodi('« upon yeiusl-fungi. (^>ee p. 8(J.) 

ExpcrimcutA made by SrAM.AX7^?n. later by Fit. ScitrLKR. SrnwANN, Hit.M- 
LTX. Hcuii"\UE.B, T. DlTwn, V d. BiuiKK. ftttjR'ciilly by l*A!»Tfc:t;R, (diow that 

snic «nbHlnnc(Hi, left to themKelvtw. »aMily ent^r into decoin]HKdtion ainniltarjooniily 

with th(^ npi>«:-an)iioe of fuDfri. ete. ; bnt that Iheite subiitauceti do not chnnpe, niid 
remain free froui fiin^uf fonuaiion. if tbcy ore uxpowMl to a tcniperacui'e nbich killtf 
lb> *■ ■' - ['urba prvKL'ulin tbi-iii, ur if ^ouh ait has mx-<.'iu to Ibcm uut of which tbu 
<>i ^ have bteii rviimvid (IjV bi'iii;: j>n>/'i;d L]mm[,'h xtdi'hnric nr.Ui, ur wilu- 

ti' 1- . , L i.ib, or nrer a ri:d hot rtiirfncc, or filt^'nd throu|^h diflinfwtrd cotton 
filtcn, or dry anitnaJ mt-mlirane). Dy placing a Uuid very prone to dccompoHitioa in 
an olriubic with rory narrow uuck. which is oi>eu, Init bout from ono side to tlie 
«ther or dotrnuard. m* Uinl tbo gKimt bappenioi; to be present iu the air cannot 
fall iuU> ibc lirpiid but tnii'tt rctnain iu lii« ni-ck, aud by boiliu^ th<! titpild a fen' 
Dituut«« :Lod then letting; Ihe TeMtd remain open, the U<ju)d will remain (ulact nnd 
free from or^^aniHrnx. I(rc:ik oil thp neck, and apw'arnuees of decompoMition will be 
Kcwnit 111 from IH to '2-i h< nn, ( 1>k Baht.) 

sftexidf^ the iuilui-u(!4> of fuD^^ in oriinary decay, it it* shown in other simllnr pro- 
BWm; ill the imtrcfuctiou ut t-.^gn. of fniitH— where the fungi peuetrate for tho 
moab paiL uoJy Uirou|j-h injured apota of the shvU or kecL 



m»or AS cAt 



Kase, 



Acnordiniy to Coim (t>ehU*. Ot*. /. riUerl CuU. Siu. r. 14 Feb.. 1875). ftll 
putrcfnctJon is attethl^d \iy Ihf devpliipmnnL of bacteria; it beginii if Lhi! %\>- 
jtearuDce nf tlie lattt-r w penniltWl. progrRWRi* re^ilnrly as tbo UtUer iuurenjw; 
witli ihe UTtiHt of the pntre faction, the increofM* of bact«riA is abo ArreaUNi, whkb 
imcipitattf a pulveml«ut flcpofdt. ur in jelly-like mniuefi (zoofflon). (like yenct in 
iboTOUtchly fermenttid noluttutu of miifOirl, B:w.'luiia art' rxcitAolH of pntrnfatTt-iou 
(taproffenouA). the mould-fuuKi and iiifiiMiria rn^']U'.*iitl}>' drvt-iuiNfl in putn:(yinf 
flabManoes ore only nttRndant-ii of thruie lAAjtrnphiliiij Infection with lm.>terift 
tAkcH pluce not throiiifli the air (Api-kbt. S<iiwann. I'AfTKt'UI, but lli. SiSDElt- 
BoN) only tbroujrb contaul with uiicbi'an 8nrfuoti-& of ImmUca (fdiiu, iuxtnun<.-iJt«K 
o«pf>r:ialIy throug'h tbt.* w-iiLcr, whk'h nluava contnliu Iiiu:turin-.:LTTUf), iinli-*« frvidilj' 
di»tU1«d. Aocordinft t<i (.', th« lraimf«t of bm:t<:riii-(r«nn»i thr""-"- *'■•- riir tnkes 
place at If-aitt with difficulty, liouturia art; nommlly developed r.' in eTery 

litiiiid which containa, besidi^ nmnioniu or nitrio acid, a iKxIy _■ carbtni. 

fre*! from nitrugon. Since ba«t4>riii lUMimilatc nitro^tn in lurni wl utiutiuuiu or 
nitrin acid, Ihetr action in patrcfaction vonnut to Iw to dvcnin|MiKt! albumiuoiiB cum- 
ponndit into ainiiionia, wbiidi \» aiwiiittluLed. and into othnr ^uMlif.H, which api>ear as | 
coprodticta of putrotaclum. Pulrtfa^^rtJur) in thn diitvintpiiLHition of alhuminoiw oom- \ 
jHtands by hact«iia in n similar iiiaua«r as alcoholic fermeulation iit the deoompoii- 
tion of lug^r by the ycnst-fnugns. 

RTNDfl.eiffC-ll ( Virvh. Ardi. LIV.. p. itnOt diHLinguiHhe»> twofuniiKof schir^niyoelea 
of pntre faction, biirUrium and mu-ninatic>u ; the fonner ia a consiAut. the latier a i 
troqucut attendant of the prooem of putrefaction. Without t)ie acotss of bacberiura I 
the common stiukinjr puti^faction doca not appear. uuIom thu couditionn of patx«- 
faction have bvcu the most favorable. Decoiupiiaitiou without «tmk (ux in still -iHim 
childn*nl ttikv-n plact; without hubiiomyof It;*, The lOi^nuN .if buctttrin arr pnmunt iit ' 
finomiotiR quantity in all Lt.TrfRlri:il moihturo The air iir^nrdly ivmljiins, r^iieoially if ] 
it hi8 been very rainy, very many fiiinpis-«iKiroB, bnt no geniiB of bacteria. (RlXD- 
ri.ElACU, t. CJ 

In how for fungi arc iircsent in the variooi foriiui of gaagTaoBf ia nut yet dct«r- J 
mined. In th« greater camber of cases, f uoguji fonnatioQ U anroly aecoudaiy. 

Coueral tlisfiisi-s, uf wliioh fiintfi imisl. witliout cUmbt hv regarded as I 
causeg, are iii linniaii pathuIogA- very little Icnowu. On tin- other hand we J 
koow of mauy vt'getuble und Hnictml di^ieiuics which ore witli cortainty the 
reiiult tff fiiugi. Ainoug VK-gi,*l«ldf diwaMea belong the so-call»tl biond, rant, ! 
etc., of our grains, the gra|>(' and |JoUito <lii^H»L> ; mnong auiiuat Uiseiisw 1 
Hoino ufrL*ctious, occurring widely, of cuti*r]ulliini, llica, vti;., bh well as gau- 
grenc uf tU» splemi of :iminniiiU. 

The infection of planiA by jWiraHiuc fiin^ lak^.* plaoe oidy nft^r the latter bafe 
Kent adrift a |^L'rni<(>oiii:h. The ^tnoH either find their way into H^snntK nf xho planto 
receiriiifr them, then pierce into tbo 8p:ices found bi/ncnth and from there into the 
InterceUalu* ducts : or. oa Si.'Uac:it ha» shown, they pciiptriki« by a aort nf atKiiirfitiau 
or chemical »<dutiou thi-on-.;h the ccil-wolU, forming sharidy defined hnUw, anil thus \ 
(TO far into [hf interior.— The f^rapediflctasc ta due UnntUnm TufJctri {ithmv., Jfittitn. 
Ztff. IH-Vi. p. 1); j.S'iJi. p. .>a"i ; \Hr,4. p. i;(7i, the potJiio-diHiJifte to }u-r..ito*f^fm iU' 
yW'/«VllDG nvilV, f>ii- tjffjriuri'irti'j hrrrnr.h. l\-irt>>^i.'iir'tnkhfl. t.*«(Jl(, etc 

The Impoi-tun^e of parasitic fnngi for the lower aiumaltt. which thrtiujfh them 
•re dt-atroyed by millions, 8in>;Iy or itjiidf^mioally, was tint fdiowu in the vo-oalltNl Mnf>' 
oanline »f the mlkworm (Bassi. IKW). Kijually noteworthy i« the fuu^'um of the 
hooiw-tly yenU>mi>}ihUit/rit *. tvtpHM'i inuArtt). At find, uumopoiut liulf c«h»rl»s 
ocUa ariae. in an unknown manner, tn the blood nf tho animal. These fjnickly j^row- I 
to a cotuddenble aixe, rotain thfir ffphfrical or eiiry fihn|>e, or grow into stretched 

SouchoR. The bock part of tho Ixwiy of thtf Ilios wt-IU out oonnideniMy. their motion 
ecomea ilow. and they die with pecnlinr Htrctoliiiig and uroukui^ of the le[pi. 
Alreouly before dt-ath tht: ftelln hnv»> cxlondt-d int<» the interior, mid liear cyrtjs with 
blind ■•xtremllieR. which ehmj^tu and branch nint-like. and mipptant and lumMtime j 
both blood and mtcntinea. In from eiyht to ton honw after death, the mcmt>rano 
between the nef^meuta of the body heoonies pierced by the eudi* nl' ihr^ rvM". nlvova 
mentioned; thegie stretch ont and funn un their cxtnttnity a l.n ••■ra. I 

which mny )w. thruwn out to a dUt-itiee of It tMiut. The dtrwl l\y - be- I 

oomeff uclotted with a white dnxt Healthy Ilics have hitherto lit..-'.<. v c in- j 

footed by the sporw. 



.^gi 



Fcnrci AS CAt'SEs or disease. 



103 



. Dh Bary haK diwjiirerefi four fliffeiwnt form h of fungns (lurinjj invwi ipationii o£ 
pillar cpiili>mi<» : fiolryfis htiinu.nut^ contf/c^jt miiihtrtit^ uiiriti J'itnwj*/! jind 
Uc obten'cd tbo ijeriiiiuatloii of niKin^ on the nkm i>f aiiiiimlK. kaw the 
penetration inward of the gcrui-)>oiictic}<. their further i1uvuli>pm»ut in thn inl«rii.'r. 
ojul tbK fdriiialion of new fnictifj-iiiB fiuigiiit. He <]*'iiion'!irnU^(l chiiL only few Bporc* 
UKvX fome ii|HH( Uik nurfauu of cat'irpillaiB aii'.i pouetrato into the inicnor ui the 
Aitimikli*. lu order to iucrooeo tuodcrutcly uud cause dcutb. Ihtrtjtui iituatitJ/ni i» diu 
o»n"r of miuiCiirdini? m the nilk wonn ; ojidyc^iM nuiiiUiU U faiiiiil im th« pupa) »f 
iXxti butt4.Ttt^ ; utiri'i pinnumi ocoun* on cat4T|iiUan wbiuli duvHatjito Uil< Nurtb- 
Genoau ptnc-forctit^ ; miiiui Atriy<nfi on tJiH UimIUm of inacct«. 

CoiiwiU FitKV i»ik1 LiitiF.Kr, .I/aA. rf. lutlurh, tJe^. tu Zurirh. Leuekt. Viixh, 
-Ine/i., XII , |v 1-14. Dk IIauv. il4. Zig. lt*07. p. I; lb, ISUO, p. ^WS. BnKFKUJ 
Abh. (A HOiurA. &M. :u ILiUa, Xll.. p. 1. 

Uougrpiie of llic Kjilitijn, whicli oit account of itn tmnMiuUKibility tn mAii, 
mnd on Aikiount: of iU lulutioiiHUip to luuliguucii putituli', Iiam KpuntJil iiit(>rtiKi 
for lis, ist produced by back>ndiu, or HlaiiK-iitou& btietfiiii, which by tJieir 
rapiil il»*vtdMpniefit in lh« lilood not rurely act likti I'emientK iu a fatal 

ktint^r. UiKtii iuocultttion Uie tUftetuie i-eachus even tu tbti KinalUtit bluod- 

rojM. 

Ganuhknb op TiiK sn.ttKN OP ANrHAi.8 « n»iuiJ!y cndcmio or epidemic. It 
oocnn pnmanly otdy id the herbitoni (nu-iiic, b«cf, alKO]>, tie ), but b leanAOtittiH] 
from t>ie«e to the cikroivora tiud iuilu. ll iit fuuud i-8|ivcmlly iu uuiJiinuJ r«{;ioiut, 
tuider tbu cuuditioiui of tnoUturu uiid hi^fh tt^miKiruture uf Uio 4uct«ruul iiir. 

(rnii^m!n4i of thu (iplt>eQ oncnrR mnHt fn><iueutly with i:arbnnclt3 ', Lf. Vi circmmvcribrd 
iTilUniiDiitit.m uf the extoraiil iJcin, .lomrtiniCH uUo of th« Ki)r]ierflcial niucona mem- 
bnueB with fihriiio-pandent hiL-morrha^c L-xndatioD, and moittly wltfa its icrmiuatiuu 
inguifrreue. Much inor« mrvly it it) found in foni) of a mure iUITum; aud furihrr i-x- 
tsndtKl iiillainiuiUJuTL In )M>th r.osfui thi^ni (pii<:kly upfiuLrft i<i:V(tr« Ki:tiL'ru] fttilfi-ring', 
atLrmlfd by a miMlly futid termtnntion. AuU>pHy «howM lh« liluod dark, leuuoRtiin, 
reildeuiuB with difficulty, slowly eiw»triil'^tiu;f. with txteuwve iuibibition ; the cpK-uu 
Ui for iLu muAt part vury Xnx^v uid Mift ; under the skin. >)etw<^eu the luuncleit, oud 
■bout the vei«»(J» arc jelly like yell-jw or reddinh -yellow fibrioo- purulent exudaLioi;!*, 
Putrcfiuuon in ni{)id. Mure mrcly thim LhciKc lociilisittionM uf ^bii{rn.-ne of tbi- hjiI(.-i:u 
arv ftiiiiid ^^nend afTcctinnit : either cti-callod aiKipluetic ur fulininatiti^f ganiTK-Ui; of 

I N]tl(M'n, in which oniuiaLt^ after (p-cut anitution foil down and nwmlly orn (piiokly 

Mivyed ; or tJie fobrdo ^;aiijrr<iie of the ?<pltteii, when, nnder high fever with iuitinl 
^■iiLU. g'rc-at weakiivw, iitupt.-t';iC(iou, etc., d<ratb appear*. 

(JAXuKkTiE UF THK grt.i£KN I^' UAN ucviT uriiiefl tpootAneotuly, but olwuyR 
by cKjutAjfioii with tudividunli, or part« atltirTtvit by this dUejuw. The uuiitti^ouHiiei>ii 
IK in prupt^rtiiin tii the itPTeriLy ntid niTut'ineivi of thf> diMtaiu^ of thd animal. H tho 
«pltwji «nd bliMxl ore moMC in feet inns, lew wa probably are tlio hide, hair, eti\, and 
still Iei4 ao the produet« of tbe^c tl^athiT. f^lne, wool). Vet these part« roluin even iu 
tbtc dried statu Fur uionthft thuir ability to iufcet. All meu are Murtceptiblu U> tUu 
puiMiii. Infw^tion affects especially forwers, Hhepburdti, tiuuierH. In tbe summer 
montha it occurs moat frniuently. 

iiani^reiiu of the tsplecii ueeun iu man g«ii>u%Uy in the same fonmi lu in animaU. 
Tliv primary carbuncle Im m<jitl fruqaent uu tbe skin, especially in tboBti porta of the 
b-fly wht(?b are uob at. all. or only at times covered [face, ucok. fure-aruu aud bauds i ; 
ih- I I iit dne lo drimoniifrnlile intKTulutiou. Huub rarer ia the diifuM: ur erj- 

» , '>rm. Hoth fnniiR "how r)ontfltim<->« only t he api>earuuce« of local UoubW, 

h o i^ro accoiupanicd by (ever, and lighter, or mare H«vere aud fatal genurid 

»ympCiam.i 

TfrE CON'RTITOTIO.VAL DrSF.ASR, OANGREXE OP TIIK BfLKKN, IS mnch lesi 
aocuniti>Iy known. It ia found HomeLimeK Kimultauc>oualy with (the prinniry) oar- 
bandb, luametimcs this appcnw only during tlw* coiirne of tbe <li»fia«e (wccond/uy car- 
baiicU-l, ftunictiiue*. dually, ic it* ntiwut. Tbe di-seaxB runs itA courve Hoint'tinieB in 
oo« <ir in n few «hiy». luftrt froijuenlly in a week, rarely longwr. It i^ ()banicte.ri«e(l by 
Bc- r ' - ' - :i. ral nymiitoiiih (tixhauttioD. pain in muaeles. and headache, jjaHtrlo 
d: n i-<ihi*«), wbirb aru fnUowed by y^neral weakl)t-^a. dintrt:MinK uputeu, 

tu.. .- j-i iMptouis airijilar Lo those of aHphyxiat ohoUini, by ileutii. aiuular ay 

pearancea arc otmcrved at the auto|)Ky. aa in uniinala. 

la all tlie»e c^jiei^. in man and animals. »fhi^>m^c*leK appear tu bo the carriem of 
Iha dijKaw, Thcue budiea disappear witJi the oomplvte putrefovtiou of Uie blood, 



104 



5UU0N.INT PCSTrLE. 



wJilrh ilirtinfriiiiilii'H thnm from tli« rarre^iiioiiJiag infn^oria. Therpwilh nliio « 
their power to infect. 'I'hey (inter the bcnty probobljr with the drink. They arc oh' 
tM.'tved ill the I'lotKl. Qritt in ftom one to Qrc hours aftet th« fimt Kyuijtt*iut»> »{ K»n- 
givne nf tho splucu. iiicrfMst; tlica from huur to hour wry cntmi^Kmbly in (|UJinUt]' 
anil accumuljiti: Ju lb*} cnpilliirics Tbr bluoi] nhittTF ihu furthrr pi?<niliarity. that tbo 
red corpuBcIca nrr plucti together nnd swim in the «;rum like «cntt«r«l irfimiis. 

Davaisk {Comj't. rend. tie. Pnatd. tl. *r,, IWUi, LVII,, p. 2!K)| fli^t fli»torei«<1 tlie 
corpattdcH of ganpreno of tho spleen, but oonHidorcd thorn of no importmice. Poi*- 
LKNDKlt iCri9ji. \tlJAchr. IHTiS) found tbem in the- bl(>o<l of ilcod atiltnaln. ilHAUftlX 
( Vni-.h. .IrrA., 1857, XI.. p. VVZ, liW. XIV., p. Y£i\ a lihort tjm« Iwfonj death; the 
lutt«r, however, nt:ithfT rcg&rdti them us bearers of the contagiou. nor nncriltcft to 
them an iDtiolngical, hut onlj n projmosfcic nignifinntion. DELAKtiNU [IKf liiitli-nink- 
hat der Schajr ?/. «. w., Ueben*. IHt-l. Itee.. rf/- At. mitl Vft'r., 1«U0, VIII., July, 
Sept.) regards thcin lu 0T]|&ui<<iii9 aimilar to ny^o!. and as the couta^nuiu of (fau^rroe 
of thB it|iU^>ri t aft^r the tk-uth of the animal ttie rod-like IkmUcr grow, tml vilrrioa 
Ap[Huir rtrint with tho jmlre faction of the blond in Uiij* dtt^ttafcB, wliil*l thw rralKtliNip* 
pear. D.U'.\J5K uVrw. \lr. In. Stv. </*, /ii"i.. 1»'W>. V.. p. XD-i. eic.i i' ' " lier 

iiiveht-if;ation«. luu) dt-m oust rated the connection nf the corpuftch -^ af 

the Kplet-'U by iuoculaliou. C^twult oImi the general tntatiac of \i.tt.i.-'.. i. .'■.•. J. 
Hfire. hith.. laVi, II., 1. Abtli., \h ^87) und KuiL^-Wi (Pitiia-Bilul, //d6. it VtUr. 
I&70. I.. 2.. Abth.. p. 149>. 

UorLlMiKlt (,V«/. ^tn'W,, 1872., No. 27.t has lately mwle clinicnl fnve5tijfiitioiiB ia 
the ox and home, oa welt lu experimentn by inoculation. He foiiml the cor]insc)et 
inL-ntioned in the blood of Bnimnls- (ifToL-ted with li&njrreue of the apltrtai. nlmOFl ood- 
fltant dnrinj; life and nftfrr dl^Ath, Tnni gnnyreut! of the spleen niay be proiincrd by 
inociilntion with tho bjotxl of anthrax witlioiit thfMH litlJc- rmU, and yt-i t\\f- bb-txl uf 
inoL'ululcd animal-f c^.-nuiiai these forme, bconnsf in thf former (l»lo.»fl of anthrwxi aro 
found the gt-nnfi of bacteria. .\ud, vicf tn-M, anthriix may Im.* prodiicod ty mocnlntioo 
with the blouU of this diueiv-e containing bneterin, withuat the bloud of the inoculated 
animal (thowing rod-xbapi'd biicteria : :t contains ^rmx of Vtaotcria. which tuny Im 
dcv«lnpf-il fuml t/utrfcin into litilp rotlnhajied b<Mltes. Tb^ chemical action of buntitrta 
of gnngrene of the aplcua in the living btxly depends, accordiu;; to B., c»ientially upcdi 
the ftict that iboy, on aiiconnt of tb«ir ennnnoas chcmioal oiBulry for oxynen. absorb 
it with great {rrued and in g^r^ai rjuntiiry. wbiUt tlicy withdraw it from the hlood- 
oori>iwc'tet). Thuh witli the enormoiiR number of ho*'t4'ria. tV.fire ii pometiwew want of 
oxTifen and nn excess of earbouic acid . dr^ptll%a. olonic convnlFiiimft. dilatation of the 
[■U|iil!i, Hinkiuf; of the teiii|itirature. anil linally unphyxia. Thua lu the ciutaver are 
found all the chuut;eH which rcmilt from powoiiing by uarbouiu a«id. The fulminiuit 
(apoplectiform) formx of anthriix nro on that account to 1>4* raiigtd in line with cases 
of death from poisoning by prnswc acid. 

Davaink found bric-toridianlso in two examples of mnlignanl puKtnle in men, who 
had died on the tbiid day of the dtsea&o. Here they were found in the eontro of the 
pustuIeM bHtwcGu thu upithuHal celU iu very larire ^'roiLj^w, iu tbe middle of which 
they were crowded ; i« tbe peripht-ry they lay in sejuLrate |^roii|>H. l<«tweMn which 
were found thi> epilhelinl cells. From hRre they penetrat*^ into lh« blood and Irmph- 
vcsMcU of the skin. Otbcra afterward looked for thom iu vain in airniioi oaaee. 



I 

i 

I 
J 

I 



Many remarkalile futiil treses, which Imve beon ctbwfrrvwl in lute ytyin*, nre 
with tliu grpiiUst pjx)bftbility relutotl to gaitjfrt* uo of the spleen^ aiul art* cer- 
tainly ilejipmiLMit \\\you bucteriu : tho so-culled JIycohib i.STKSTiNAjas. lt« 
esacntiiil coiiilitiuii canRitttA iu tli« occurrence of grt*At niiintH*ni of vibrios 
rikI iMictcrin iu tbe blood ; iu h reHulting, intnitly cii-ciiinBCnbr-d ba>raur- 
i*lingi(N>-[iuni]i'nt iiiflanimatinn of tlio mtirouK, or, at llit> Mune timr, of th« 
Hub-uiucuas coatti of tlio stooiHoh or intt'tatinHS, or of both, witb very abuuduut 
Kchixouiy cotes, niid in uotisfcutive alfections uf tbe lymphatic vesseU and 
glaiulH Wluiiging to thoxo orgnua; in vanous atfections, innnninmtJjr)' or 
iiUTuorrlmj'ic, of different otgiiits, dppendent \ii>ou ibe flame fuiij^i. Tlie dis- 
fiisM iilway:* ran a very acut* cour»e, Tbe n^-m)jtoms wei*e not very charac- 
teristic: tbifv belongi?ii for the iiioMt jiatt to tlii* 8U>mucb and iiitL>Mitios; 
ii»nally high fcvcr and acverc brain-itymptouu. The tcriidtmiion v/bh alwa^n 
fatal. 




IKTESTUfAL MYCOSIS. — DIPHTUEKIA. 



105 



Tlie finit. jret not dcnr camct of tliia intcMtinnl inyraniK were rtsmrdcd by WAnT>- 
VlRf IIMM- i.lrfA. im\. XXr. p, .'iTJ)i. nn.1 V. HufKf.iNMllAirHKN' ( M. I8H4, XXX.. p. 
86fii Then follows the iniportiint ol'wnatiorw of Bi ill. \ZtM-hr. f. /ttof,, 1871, VI,, 

tlitt). Th€'«i were coroplfiiuentori hy tho co'ieH by \Vai.i>kvhii ( Virfh. Ar^h. , IN7I, 
II., |t. .'»41 ) ni»(I by the unUior {Km Fall t'm U'lUH^fm' P\kkriinKh<-it, Mfffmiii I'nt't' 
tinntis. J'\»tjf/irifi. 1H7V. ) t'oiisuU abw >"KYl>tso \ V(!J*ehr. / y*/-. J/f//,, 1^419, X. 
^ Ml) sad MCkch (Jf<t/. artM., ItrTl. Xo. 61). 

In thi* sninc way as iu the nfiVctiniiB iibovt* mtnitionM, tlie niorlc of origin 
of olIdt tiini'iuHfM IS not y«'l. provfn. Muuv Hi'ute iiifvuiioiis iliHciwca t'*]»«- 
ctnlly, \vlii(!h are Cfituiiily ui- proUiibly cuutji^iouH, liave Imtl their origiu 
troffJ Lnck l« bncl^rio- The giouinlo athluor-d for ihia um ]ittitly (heo- 
retioil, partly thnt ihe fuiigi have ItHrii octwally fouixl iu Iht- diM^itNcs in 
qiK'stiiin. Aiiumg tlio thtrnrctical gi'OiindK tho iiioKt wcighly ure : ihu Kiiui- 
writy of iimity of these diM-'itacH i<) tho»u Hbovu duM'ribed uf iiIhuIh and 
jtniiiiftU, I's^wcinHy gnngreiiH of the Hplnon ttnd rnt/ronis tHtrHtuudU ; the 
oourMi »f uiuiiy epidtiuiiett-ouiititgiiiim dist'iiscH iii iiidivldiml otiM's, itud «'it]i 
neftert to epidemics as h whole {simiUnty with reupwi to the periudtcul 
comings ]«[)r«-tid, luid djicippf^fttuuro nf iiiHny lower oi-gHiitHms) ; (hi>> inft^otionK- 
niii«w of subhtaiiCHS whii-h h.ive beon uvaeiiuted by tin* siok, fen* the iiioKt 
I«.rt uhly «ft*r a certniii time; the In|>se of a fixed time botwcen the nmment 
of itifty.M.iou uikI the begihiiiiiguf thn iiyiiipl<jiit& of dii»eHiHf (nit if i:K<<(iiiti]d dis* 
tiirbutiern iip|Ksiii*il only iifier an iiieiiiaKy of iho fungus -spoiv-s taken up in 
the infi.-etioii). 

Among diseti>«s in vhii:h fimgl havo. been found during life (in many 
cxndHti«ini< nf ihe throat, etc., in intestinal evacuatiouff, etc.) or iu the 
firud bcnly, or where there has been a Hiiccessfid inocnlHtiou, bchtng iHph- 
theria, pyn'iiiia of puerperal fever, aninll-pox. In miiny of theHH dia- 
eiuM-)) inlcctton tuki>K phicd through woundii, et<.\ (nee Pyietniu), in othera 
pruhably through the iiiHpii*ed air, or by food and driiik», ttipeeially driuk- 
iug-wnt^r. lCact«riu app«'iu' free or iiiclor>e(t within white bltiud-tHjrjtutirles 
in the bloin], and therewith into \ariouK tiH»ufK. I'liey tinitlly diHJippear 
in ail unknown manner or are exci-eted witli the urine, unlenw lU^ath aouner 
ocmr&. According to different obser\orii, bact^'ria vaiy in different tlis- 
eusea (gaiigreut- of thti ftplfeii, tliphtheiia, ]fyieniia) : tliey lielong collect- 
ively to the iniinnvable glnhular iMeloria. Itt»idefl, Itacteria are probably 
iml indi\idua)ly injurionx, but taken into the blniidvi*ft^ds they caU3«i a do- 
coujpi>«ition of tho blood, and give rise to poi»ououd sccoiuhity pioducts. 

MoAt tmnintNU invtwUgationH ooncertihig the paraiutic uuturu uf thiwu diMiiufes 
hkVf been roadie iu epidemic i1i|>btJuTi.i of thti thrixtt : TouMAHt-HirtcTRR, Bi:ui.. 
Oeiitei.. TliKMiKLEMHiio, NA(*ir,oFK. Utire lire foiiuil niicrooccci anfl bacteria 
fur the mf)"L )Mtrt in euil]<;»Mquaiititj'. not only in th« epithelium of ibf tlii-n;)t. in the 
Jtruti]^ oxndjitiou eL-1U, vtc., but aJiM> in the luucuun mnmbnuie, t>iib-iiiiiuot)H tinKuc, In 
the lyiiipharic vcflM>U onJ glanJn which Ix^lring tn Lhom. in tb» Itlood. uiiil further in 
tb«- tuQLia. kiducj>, in thv urine, tn the ttpk-eu, ct«. I>iphtborin hti* ti<:e.ti uonvvycd 
Vi rabhiia. by iiitroihicing diphthoritic mft«*;ii into thfl opHnod traobifft (TnKsnKi.KN- 
Bt'Ko. OtiiTKr.), Aft'ir JiiucnlAtions of diphth^ritie motnWrnnf>« iiimIpt tho ekin itntl 
intii th* nuuiolta of rabbits, there ari*c« an ultoyotbrr siwi-cific i>r«*eLrsB. which js dia- 
tJogiiiKh^d from tbut arinIiiK after fiiuilar iiiociiluttotu) uf pyutmic |iiik. gan^rroiioua 
tiasu(!>, piitrt?fyiii({ KiilMtiuicftM, ele. ; tlit: orguuM tuid the bloud m the furiiitr ooutain 
niUioJilM of micntcocri. etc. ; in th« latter nuue lOKitTKi.). Siib-ntam^'b fnini auiiunts 
ij«cl(^ To thi' foriiirr iufwtilntlotm ltitn.MluciHl int'O the air-]Ku«ng«'<t (if rit.her ntbbito. 
__^ dn CAUM liiphthflrin of these pOAKaf^cfi iOkktki.). Micrococci reach the interior of 
o^Im •Ither by |w;rfiimtin(j tho eell-membrflDc. or the hyaline pUsma-colis surround 
the iHK-ci :ui<i innltioe them wiLlun tliriiiHi^lven. They then taki; up the uitto|;euoim 
nutritive uul'staneti into thetunuWeii. mt tli«l a eell is cout»;iiiied in Lwenty-four huuni 
an for M the ce^l-mentbraiit}; thej aepurato and qnickly iucrea»e (.'--We ii-fnt^ diph- 
Ou-htic cxudatiuD). 




106 



DIPUTIJEUU. — rL'KRl'ER^l. FKVKQ. 



HtiKTKii i^fed. CmtrnUA., ISaS. Nni. 13.31. 35; /). ZO^Jtr. f. Chir., 1H72, I., p. 
\H. etc) baH dctuoiuttrated, oe H exp«nmtntall.v, in ttic niok. that moDJida id^rw/zW) 
(Ic%'cJ»|iiiiK in K>'*''(^t uutubtr iu piitrefyiu^ bloud, pt-iitdrale vcqt Itui^uly into llTiiiir 
tUsueH iLiid itit>j tlie uirculHtiiig blooU, evt:ii hciu'e- tbi.*y luo^ appear iu Che itecivtioiM 
of ttai^ UmI>', uDil y>y thr.ir uxUmt ^vi: tIm; tu iiilliunmiitiiry proceMWR vf Bp^uilU kind*. 
eirpeciKltjr diphthertik, fniiipeluH of wounds, so-cnlltid di|ihthcritic phlegmon. Dcudae. 
tnoDftda excitiujf putrefactiou may penetrate IhrouKli the vewiei-wiUlii into veooaa 
tbroiubi and thus give ritte to pulrcfactioo. oml>oti. and to uetnatutio int]amiuatiou&. 

Accontinj^' to K.i.KUS[ Jtciti; zur pitUtM. A.H''L (f. SeAuuie., lUi^J. elc.i tbt^dnlutcnoua 
ohnr:ict«r of pUK. &h u-ull an tbu gtiuunU infection (pywmini &)t}>t*iirin({ durinff AUp- 
puration, in du]>endoiit upon th« pnweiiiw of Kcliixotnyc«t«K iKl.Kii^' mirrtifffr'/H 
ai^»tie»tm). Thew gTuw on th« (lu'faco of woiind«, ppuetiato into tbe titsnc.4, indooe 
decoy, (uid r^ach the blood by jjerforotion of the Tewtel-woll^ They are the cnosei 
of weoouduy iutlammatiuDa nnd tiiippu rations. Kl. eouBnns tbtsno olatoioeuts kImo 
by ex[<eritaBnt.. Hu iujecLed ooimtdM with Unidfi oonlaiuiiig fuu^n, which often 
f)aupM>d very widely 'ex t«ncttid mippiiratiooH. and until duath oontinual fpvwr. The 
Mime lloids lilt^red. tbrough a day cylinder did not induce sappumtion. but bigfa 
fevfr. which in one to threo days poiswl away. (See, in oppoaitiou. Woi.Ky. infni.t 

AcooniiuK' til Kl.KBs i7'(j/t//t d. Not. Kp/-«., 1872, p. 312) bhe dcvelupuicnt-of tha 
inicn>c(K:ciLH doe« not tak? place in the blnotl of nunnul aiiiiiiftl» under cotiditious 
in wh'.tih ih'^ bUHxlof animiU infected with mtcrocof^m^sbowii n great dtivtdopineiibaC 
tliesc. The dintribotum of micrococci in (W|»«ut. variola, and rlndvrp»:«t offiini dif- 
ferencea so chuuutcrutic. that a Kpvcliic dlffurcnco between thum muat bo aMuined. 
(lvt.uui>). 

RiM>Ki.Et9CU {Lthrb. der path. GatetM., 187t, p 204) had already ahown Uua th« 
Rmall abin^i^ROfl of thu hnart iu py»<mta. punrporal f«Ter, eto , oomdrt only uf ribritM. 

The solHtutAneanfi inj'jolionii of Ki.ni»\. urcording' to which only the fuu[fii(* ninflsos 
OQuiiO local Guppunitiunii aud until dt^ath cootiuued fcTct, the hltrate, on the other 
hand, oulr tmiudent fever and Dover local stippumtioii, afforded iu the haodi ut 
Hoi.KF (fWi Vtriltl. \H~i.\. No«- H, 11) otlu'-r renulU; he foaud in ruhbitA only a 
gKuhiul ditforenoo bfitweuu Uio actiou of the filtrate and that of the fungus-holding 
Hedimvnt 

Acconlinjf to EiiKiiTti'^ (Sfcd. CentrnUA.. XWti. No. 8) namerotu experiments, the 
nkiu of Kit' i-abbit booanien dijihtheritic by inoculation of the diphthetilio la}'rr from 
the throat, of thn endooanlitil deponita in pnmnry innlit^riunt unilDoanlitiH, of th« 
diphthtiritic Inyor from thfr mouth, of the pu^ of inilnmL'd veins, of thotie of pyntnja, 
of purulo-cronpouB exudation in pueri^ral prritonitib, and of the blooti In mjims and 
diphlheriu of deiul lyiuK-lu women. Acoorditig to K. pytemia i» mostly a diphthorik. 
iliuiy Forni.t nf iM:pLico>pyii.>uiia nxe L-ompound mycoi»e8 uf Lho baoteriu of diphlho- 
rin and putrufaL'itun. PurLln^r cipfrimeutM twtublishud a quauUtativu dilfcruncv in 
the cfftrct of biicteria of diplithL-ria, and those of |>utrefnctic<u (on rott^-n tlesh, in 
putrid iirino nn4 Lilond) ; they make probable the differcikco of the^e or^nihmB. 

Con^iiilt also tho earlier observation)* ol Vikciu»w ('»r*, .-I6A, 1^15(1, p. 7W)* and 
BiccKMANN I VitvJt. Arch XI., p. H4|. the manifold reitcarches of Coze and Feltz 
i^Reefi. c'.ift, tt fTper. xf/rttmnutL infrftieujie.^, IHja). 

OltTtl i.iirji. iter Ht'ilk.. 1H73. Xtll. , p. •Jd) dn^yiljes a case of wptio myooiua in a 
new-hotn infant whfwo mother had panrjiHral fevHr. 

\V.vi.tn'.VKi( (Are/t. f. Gj/jtdfc., 1H7'-. UI.. p. :2U3) found abtrndoot bacteria In the 
diphtht-ritii: ilc|KWiitt( on thu iiiaL-r KurfaL-e of the puerperal utfrniB, in tho {rarifonn 
nuiMWh Iff the lyniplmtita of tho utifrus and il« uouue«tioiu, in thr poritioneal, ooce 
uUo iu tbe pleunti and jiericanMal exuilntitunif. 

IltKMllKLi.u <.IiyA. H. Uriik., IHTS, XllI,. p. 4K1M. in numeronn cosea of fatal 
ptierperal fever, found ralcrocoooi free, or in ooloiiitrf on the puerperal nJoeia, in the 
Durroiuiding epithelium, in the submucous ti!»iue. iu the lymphiititts in the pejviu 
ocllular ti.**siie, in the esiidalion of serous eavititw, in the ptlvic lymiih-j^Hands. tu the 
Bpleen^ cUi. Acconling to his expi-rimentA tbft whitu bluod-eorpUMclus lake ap the 
mioTOCOcci in groat unmbeni ujtoii the, iniro<liicti>>n into the blotfl of moderate f|Uaiita- 
liies of iitinid enntniniog miomcocci. Thf* spleoii retains a part of them in it« pali>- 
ocU«, and whoa they are abiindant there appears a distinct ftwelling of the orgtin. 
ThuH in exi>lained according to U. the couxtaut occurrence uf acate tumor of the 
■pleen iu the dineaiiui in <|uejition. 

RKt-Ki.i?iuiiAi:sKN {Vitrtniff in it. Wi'irtb. phjfu. — mnt ffet. v. 10 Jnni IWl) 
fuond in a whole eeriea of inleotious diw*-a«tj». above all pya>mia and puerperal fever, 
beeidex typhoid fever, acu&u rhcumatiKin of the jointK. ititiltnitloc of uriuo and pat- 
monary icau^n^nu, as cuuM:sof the uiiiltitile metaatatio fuel, with aWenoe of a KUnolta' 
Booua eudocurdilu), utilincy acuumulatioua of Kiualt oigauisms, which he regarded aa 



I 
I 

\ 



I 



TAKIOLA. — «RT 81 PEL A 8. 



mloriWOOai. R. fl^^^^BflAlBf funj^s iu the kidnvyK mvpctiially freqnctit. itouic< 
timp# wtitl '[nite ^i^^^BQQHBiy runotive appeoniiico, mon: »rt(.'n humiiinilud bjr n 

liii ' too« or pamlAtit iuHltriiU-<d tiMUo. 'Thvy nre found not uuIt in ibe 

]il . esjieciallj tb« Kitiallf^^t veins, bat nlbo within Bovrman'^ cAivHules and 

nntiiirv iiu'iili. urbere thoy llofttfij avny with the urine, uh u'lm lihown in thr t<iu- 
tont-t nF thi^ til:idilt:r eitltur iluriiit; Ufc ur iifUr dealh. Tlit- filling uii o( tbu*>0 (li(- 
frrr-iit • i."rm<>tn IK ofttiii Bu giL'jil, iJiuL knot-Ukv BWelllngB una*;, whicfa go ou to pcr- 
f) I •Kcnpw t>f the fuiijjiiM wvJiiHiH, 

.>>rni nltopvUior ihtlor^^nt fmin the microcooctu, whioh oonnisbed of 
kiuilLy ctMix of grt^eit color, wiu ditccvvered by II. in a ca»e of tcitrlpt fever, om el«- 
tomiu of Biintlnr »mull foci iu tbu roniil pyrninidii. The uriitc of Uic aide ponon, 
who AiffA iiu the Mixlh day. t-ontaincd cu>il« (M^vttrcd by tbe sumc elciiiciilJ*. R re- 
ffonlK th(^w inetaxttwpA of fmii^iiH nritan ciiib'tli in tlit; ttt^iiHe iu)o)ili»l liy ViiK'IIdW. 
Tbe coDtmiT is ^own by tb» fivqiu-ul t-xlnivascalar po(»itk<n of ibe mibplocKd niate- 
iml I H tMuud miorooood uIk) nithiu tbe pulmonary alveoli), and by tbe abeenoe of 
rndi>c»rtliiiA. 

Whl'ifcBr lW'/. ('fiUnii/d., 1871. No, Mt>) frmnd in thn pocks of Uie dead body. 
vbicb wi:<r0 mot<t (1ev«lo)>iH] on the uxth iIav after thft a.piieanuic<: of the fi»>t m^ of 
tbo exaatbeiii which fnrttKtr, at leatit in pnrt, ha<l an bajmorrhofpc charnvtft, bnut^srtu 
of the sniAllcal foriu. Tbej luy in pouches, wlucli peilmpe ooiTfupoudt'-il to tbn lym- 
phntliv; especially iu Ibe Wcinity of the }KH:kii. Tlio name wiu> tvea tu tho email 
cntAticttu'* liiLm<jrr)uu,'eH. which are found lo decided biumorrbagjo o«Bes without 
or writb indtniinot ptii:k-forTniiti[<n. 

ALX*Dtdin]f Ui KLKtth iAre/t, j'lir exjtfr. PtitJui. I , p, ^1 ), giant udU oconr in tbe 
cpidcrmih in vori'^In, vrbiuh celU are developed from tbe micrcitirto^i in the n'llft of the 
aaiinol uiteiLintf the diieose. Tbt^y conluin KoiitctimfH miny, sonietinu'it no nuclei. 

F. Coijs y Virfh. Arch. IM72. LV., p. 2.'(!l>. likewiup Kkiikii and others, hove demoD- 
itratrd in the lit|iiid of tbe vooeinu nndviuiolu pithtiile living' unteellularorg»uif>iua of 
tbe gTi>U[i of Uu* HO-calletl [;liiliiilar l>iu;l«riu ifJiVrixyi^fn/ii, funiily of the dchiaainj- 
c<'(. ' . ■ )>.-y are coiijttuntly preaeat. luid in tbe tfreuteiit DumlMr, oud inareue with 
c\ y •juickueNS. 

I Wirn. mrii. Jithrh. IBTV, p. 414) foond the raiorocooooB <moe la pntlid 

bruiii.iiiLLA, wliere tbe Inri^'c and nnall bronchi, and eii[Hy:]ally the alveoli, n-rre ulmost 
euticely Qlle>l by it ; tike-wise once in diphtheria of tbe luiynx ; once in vnriotu bmoi- 
orrbapcu in the cnpillaries aud puluionaty nlreuli; twice in imluionar^' ^nDgrene. 

W*l.PKVF.Il iSchU*. Ue». f. fiUritind. CuU. A, Am;. 1>*71) anw uijloiiicn of Imiteria 
in the livt-r, Ktonioeh, paueruaa, MupmrL-nal ca|wniIcH, wLen." they apj»cared OS 
Uaek epotx <-f tbt^ wa^ of a (frnin of wind, in n coho of acute diifoK*! beputiU'H. Also 
many bnn(lr<>ti4nf miliary foci of bacteria in tbe llesb of the heart in pyieiuia. Uao* 
t«na were the «oIe eauNC in fnnr cosies of mihnry al)«ce»»-like foci of tbe kidneys. 
W. Huw uIko many caMM of hsuurorrha^'ic uephro-pyeliUs in varions amtfl infectiuuR 
diitfiuM^ wher« iu the mucoux meiubniuu of tbe renal j>elvia, as vrcll as in the blood- 
Vew^eU interatiliaHy, cuhmiwi of b;M:U'rja were found. 

K-M.l.lKK nnd nUiem fmind in tbe ibMeONen in qnention. nnnilM-TlPKB niierccoeci Ju 
the blood, wbich by cuUivntion have L-vrminatwi and paased into known fniiyi (in«a- 
ale-A : inHCT lUiKtilo ; typhoid fever : rltizojma lu'gr.'fiiiaa ; variola : fiirotuiin iterfKir'tm, 
etc. ). Lkt7.kui( II nffiriiM the Kaiiie of wlioupinif-cou^'h, Klkii« ( VerA. d. H'uiyb. Vt^.^ 
Jnit,, iHT't) deitcrilH'.f! a microcnccux in meoHleo. 

OlcTII {I'-iyrli! 4 X'ltitrf.-lWu., iHVi, p. 214) inveotigat^d traiunntio eryhipclas 
pathotopco-anutomically and experimentally. Ue found in tbe dntd of thiH aifectiun, 
bettdea various numeroiuf red oiul white blood -eorpunoles, euormoiiH uiasfd-f! of bau- 
teria. 'I'hcse were for the moat port oval, in part also rod-HbuiH-'d. Thoy wi<ru 
atiMPiit in interna] or^nit. Acoonlin]* ttt Ortti {.-Iri-A. y', i^ji. I'ltth., IH*:!, I., p. ^\) 
epidemic «rT«ip<'U* owes ibi orifno Ut a ]K»iw>u contained in the blood, nti well im oupeci- 
aily in tboafftH;rei]part>4of tbe skin. It may bo oommiinieatcd toother iudtviduAlti by 
inoculation with \MvKti tliiuU Itactcria jro haad iu hand with the development of eiy- 
*ipebu. The cbaraetemiie symptoum of djjwaoe may he produced also by bactana, 
wbieb hikve ber:n artiticiitlly ctiltivatoiL Bnoturia are. buwever, only the indirect 
ejiu>eA *>f iWnt-nx^. siiioe they arc nut found in yreat quantity in the bloofl of tbofte 
],'- M > \-:.\ since their destruction lessens the netivity ot the liifectloiw lIuidB, but 
il ■lily deslr.iy it. They Iwloajf proKftbly t<) tiitr [jlobuliir bacteria. 

I iin and Ui'TKit {Mvd. (.'(rIfjL, 1,S7'J. No. 4!li inn-sLigateil the yeneral dis- 
t^irbaiicoH of the clruulatioo after iiifet.-t.ion of frot; by tluidit ooutoiuiiiK mocual^ 
Tbe whit*' bloo«l-coq(Uw]len adhered in gi<jat nomber to the inner wall of the blwid- 
veA-irbi ; hat only a few wandered out, .\ remarkahty great number of capillaTi<--s 
wef« excluded fruui the oironlation; thia is froqucnt^ can«od by one or two wluUi 



VtrNQT AS OArSRS dp tHSEASE. 



blood-gloliules becointDg ndhftrcDt at the point of exit of tho captQanes, Stow uid 
Incomptote oinmlation -khs fonnd in other cflpiUaries. 

UDKUMKtEU [Med. Ct/Ufiiiri., 1873. No. U)i fouud in remittcoC ferrr duriiu; tbe 
hot ittaiiru {aot iti the remuHJoti, tuid shortly bofom cud duho^ the oi'iiiiti) very Iin« 
fU&ni4:ntoiui (ortii)', which poiMcaiied a very rapid uiuvL-mcnt: tiic mov^QXTUt ci>ui>iiitcil 
partly of iiiulittnti'mi' in bh« filament ili^ilf, partly in mirviug>>, u<irk-(«rrff:-likf, i:U;. 

Cholera ulso l>cloiij^i4 among thcwe diwuipex in n'hirh j,'i'nesis «f fun);^^ is uUvoyw 
brought forward anew. AEtfir the oldsr KnyliRh data iTwayhk nud Ukittan. Wil- 
LlAMtt and uthum) had bceu ahowu in pari to dop^'Od upuu g-rou uucrueeopicul Ulu- 
Kionii, the uioru ruueut. oncii of Klou. TituUK iLud Hallieu mtil with a. siniUBr fal*. 
Ill dinrrho^iw of every Icirxl, (Uko tifbir laxativcn) (Milphato of nin^rnfiwiji : KvitKK), in 
dys<<nrery (lt.\M'H; the liiwer vegetable nrganliaiii am gri^ntly incfMuu^i, ViK< iiuW 
(JrcA. XLVII. p. '>'ii) fouud Uiu same in a onwe of yery ncnte anionic- pwisouin}-. A» 
little dtauoautraud arn the faD^l of totermitteiit ft:ver (Halisbcrv, owl oi^n^ 
How wualy, even tba most expert Imiolrwiote fall iuu> (,nru«M tTMr^. i^ iihuwii by tiia 
strife just eoded over the corpiucle of eyphilia (Si'itu hkh, LuKTitiiKKit.j 

Id tlie foregoing are tlie woRt itnpurtant afTt'otions, which nccofiliiig to 
many are cfrtiiiiily caused by fungi, Hcconlin^j to vilivnt only |M>i>8ilply, auil 
which also bavo beca the source of sonio doubtless erroneous views, 't'tierciii 
also has iuocubiiiou ofieti been made ineutiou of aH proof with res|>ect to 
pathngeuesis. That in tbLs the greutirst precuutiuu with resj>ect to tbe kind 
uf material to be inoculated, thti perfonuunco of tho iuoculatinD itActf, finally 
the criticut exautinaiiou uf tlie result iu necessary, is at uncv umjei-stood. 
But, esjincially witli res[>ect to ttie firat and most important (Ktint, thfif have 
been the must frei|ueui uiiKtukes : it preliuiiuHry cltsir i*epr«*Mehtatii.in of (liu 
elemeutji of the ijueAtiou Ik yi-t wbulty iiiijioHHible. The ho-cu11<mI i;ultivntiuiu 
are wanting in most diractious iu eertiiiuty. Kveu the bt^'tit botanists afttir 
inve«ii^utiug fur years those fungi which ni-oof the greatest imL>urtance for 
human pathology, deleriniue only the »o-c:illeU ''physiologiwl' and patlio* 
logienl speeies. Finally, it Ui cuiiftpieuuus, that until now no two obttervttrs 
liHve, euncerning Ihn same dixeasc, rrucbud the sauio resullti : th*.* hpKrifie 
fungua of one ih diiiuvowed by another, etc. Hut, in»piu*of all thai, iinicli 
ia yet to be expeeUMl from t!ie farther cultivation of lliis tielJ, with iv»(|i«s 
(o the tetiolug>'} et«., uf many diseaKes, 

GBOnR {GreifttP. mM SitTutiffnhfr.iBfKi) law death apjwar 30-31* hours nfter injcn- 
tion of 3H C ocnt of fspore-fluid into the jagular of rabbit*. At the outoj^i frchb mtllary 
tubercles or nodtUar absceaae*. whieh cnn«Uled of fungi, were found in the luo^a, 
heart, liver, ktdiu'^'a, mueoua niuinlinme of the di^wiire tnirt, and in<i8cl{« of tba 
body. By injuction of tlia same KulMtuneu into the carotid, uuiner^uH fungus- foai 
were found in tho snb«ta)ice of the bniin. vitreyns. tko. The fnn^'i dcvclup wilhJt 
the bluDd-chonuelti. their lamiticatitin at fir^t fottows the courw of the bluud vl-v^cIi; 
farther on they jfDnetrutc Ll»rou;;b th« ve*w-'i-walLH and develop further '■ " ■ ■ -<n- 
t*h^ nia uf the tir^'oim. G. fmllu the prouL'ss in^iTf/tm yi lu rulia itnuiUniin'i, /■ V. 

By iujecttoii of tho s]>ure-duid into the ntM^iiniintl ea^'ity tbcnt vrrte <!i . -'irtk 

on the peiiMtnenm and itfl foldet, oommon and mycotic tubercle ; nftunvMr<l»i alaoia 
the liver, kidneys, leaa iu the lun^fs and tnnncles.— Ouiuiult bIho Bi,ock., i^itr. a 
KfMiti'i**. d. I'lfibiUtuni/ ill den UeiffAfu rf« Otia: Onjitti., Stettin. 1870. 

KE)IMUn ( VircA. Arch,, L. , p. 15H). in two aeriea of exp«ntuciiU«. injected into tha 
blood finialirr or larger maiwes i>f sporen and yc-wt of jifni^'J-'imn ijlntoua^ without 
imptirtant oon.iiHjnpoepR. The uaiiie thing wait shown, whon in AiMitinn niicr<My>o:a4 
or aitriiococx-u<t yoast was injected Uot. iu a case in which gTu\ffr'H*i "t tlie rpletti 
a^In u]>)>eared from infeetioa by fangua opnrcB and infcroeoe^^iirt which had bivn 
cuIUvuted from the blood uf the munu diMuuw, the outbreak oixnrred on tho ninth 
day after injection, and the full development on tbe tenth day cau^td death. 

(Commit al«o: Davaiwk, .tivtrf. dc Mid. de Parin, fi-tine* du Sl< Jtinrttn-, 1978. 
Debate on tho Germ Theory of Diseaae in the I*athDlo|rical Soa of London, iu iMntft, 
AprU and liny, lb75— El).] 

Numerous otiier reseai-^liea aro not given hersj t>art1y becatue of deficient 



I 



J 



ANIUAL rAHAi^ITES, 



109 



much] knovludge, partly bccattHo of tlio frivolous com)»Arisou of fuugus 
I with cprUin affL-ctions of timii. • 



B. AMJUAL PAnASITEs: ZOOPARASITES. 



Animal pornsitMi inbabit either the outer coverings only (ectoparamtes, 
e])izoa), (ir ou\y iiittrjial tirgium (eiitoiwrHKltt'a, eiiluzya); but thi« iliHliiic- 
doi) is not strict. 

Till* niitst freijtinnt locationR of animal paiiuitos are the akin and intfs- 
titii-tt. nt-vi>rtb floss almost every orgau harbors [inrasit^s. ^lauy [mrasiteii 
live odIv in certain organs (f, </., the encyatwl Tricbiua, thu ytioufQ'lus 
pigAA) ; oihi>r& aiv fniiinl in ilifTrTeiit orgaiitt {f-ff-, ( V^ticoi-cus anti KcJimn- 
coccus). Many parasitoft ore found only in niHn (»?. //., l'eiiieulu« cnpitiA, 
Botlirioccphalus latiiH); othei-s are found in maji and auiniaK (e. f/., Trichi- 
nftf '^'"iixua he|»iilicu]u) ; but veiy seUiotu in tteverul cluHseft uf oiuiuuls 
■ {t, g.^ Tiichina), 

The natuial history of many para«tf« in almost entiivly unknown, while 
we posacsB the fullest knowledge of the origin and development of 
others. 

In general, the characteristic periods of the life of the entuzna arc thi*ee, 
for the most purt Mtagea uf lievBlnjtiiient fonnally dilFerent from one 
another: the embryo, the intermediate state, and the malui-e animal. 
The embryo detttined Xo produce the panudtic Htnt« rcnmins mostly 
P&s&ive ; tho intermediate kI*i^' lakcK up tli*' pi-ocess of devt^Iojunent and 
carrifjj it un )>n far Ihiit imuH'ilintL-ly ufter piiKijiug iiiLu tin- lliinl htiige ma- 
turity uppearn. Tlie life of parautirs is dihtrihutod. dependent upon two, 
and eveu more bearers, of whieh one harbors the young, the other tho ma- 
ture animal. Theite beareiti are suuiellmea oidy individuully diirereui fi*om 
on? another, as in the ease of triehiua ; moi^e often they belong not only to 

E"'"'*'3i-cut spocica and grmi-a, but even to difft it-iit ordem or claftses. The 
y shit^^'H of indiviilual entoz«.>a nre fuund e.*tpecially in ihorti' nniniuln 
eh serve as food to the beavers of the j.K.'i-fectcd parasite ('-^ ^., the [>er- 
' fci'ted Tienia cra&sicolliu Uvck in the intetttijiea of the cat; ilie yuuiig form, 
^^ CysliceiTUS faisciolaris, in the liver of mice. Tft>nia solium exists iu 
^^poiith in swine, kc. 

^^Hbt> fiktc of eatoMia dcpcu<U uiure apon chance thau thut of any otlier animals: 
HV ovum must find itfl pnipLT Ik-htlt. ami tbo latter muul, lat^ir oud at the right 
time, be enteu by another and prt>|>er nninial. Indeed, the inure (Complex the hfe of 
B panunto is. so much smiiiler is the probability of its prosperity. In the eai«e of the 
tape-worm, ont of eiglity-iive uiillionH of e^gs only one in tlevrloped iiffain into a 
tapv wuriQ. Oiily the vuonnouB ftirlUity of parasites eoimtorbaliinccst Ihiti lo&s. 

jHjcbe inimigratiou of external pHrnsites upon and into the biimiui oi'gan- 
Itfni IS luu^tly tin active one, th^t of interiiMt |mrithite» tnoHtly a jwssive one. 
I Xli e miwt frequent and cuimtaiit source of tliu latter \h the Accidental in- 
iucUou of ova and the young. 

pocini Attention la due to sclf-lnfuction, e. ff.. In Tfcnla solium (never the case with 
pa mediijcancllata), the wormx may dircetlj chauK*! thi-ir alxxle from the iutes- 
I mto the fltomnoh, or by ootcance into the latter through the utoatb. 

riie lUKiTiHiTioN TO HKi.MiNTiiiAf^iH Ih a gpiHM'al one ; age. Hex, and nation- 

Jity niake a difference only becautte of incidental ciiTumRt^inceK. The 

ucy of wurtU8 is limited above aU by the ojtportuuity of iniportaiiuu. 



no 



ATraiAL PAHAOTTEB. 



in which onstom, liabiU, ein|>lo/ineut^ nnil mnuticr of H\'Uig exert un im- 
portant iitUueiice. 

JewH und MuhararacdanM orn seldom affected with tope-fronn. bvcaose Lhej' do oob ' 
flnt ]Ktrk. Itutt-ju-rK, (xioka, nnd dometttics hmrn more frequunt o|i|)ortiitut,Y Tor in- 
fuoHon witU iiunin ami iridbtna. Childrtin lUid the iniuifl have Uiridul-wonnK aorlj 
roimd-wurins more frequently thin ailnl*«. Uaolennlmess in(1aenee« a cdiange of 
|jl&ce tesa titao Cho tUation of the skici-pAnuitos. 

TbuH u explaiued the flependeuco of certain fot-niu of helinLuthiaus ui^ot 
circuuistanceB of time flud place. 

Thp thread-irnnn mmcti under the pbTiticdan'ii oarp moAt often in antniim ; the 
tapv-wonii oFUfaur iu HUiunier; the Jtlirtii mtdineintia most often durinj^ tbe raiujpl 
8eA4on_ IntefttiDnl wortna nre mo<<t frequent in people living in n natnral Kuue tial 
tropicat imd other cxinniritw. Erury uativo Abywtinian, from six or wrun yean of ' 
age hiu & twain. MtMt l-Jiat-IucUun net;rncs aud laoet Hluibwii hare thrcnii-worma. 
Iu North Gi-rinany, whii-b is [iut*:d fur itis iiwiuu bnt-diuK- tnpe-wonn in oftuiipr found 
tbim iu tlie South. TIiomj Icclujiderx who live cIom-Ijt witb tbeir doj* uflcn hnvo the 
ecbinoooocQfl. 

Tbe t^x^o^jTaphicnl dintrilnition of nnimnl parasites depends priucipolly uiiuu UaX 
of the iutcmiediutiU uirrierii, from which man receives these paraoateA. 

Animal parasites affect the human oi-ganism injunonHly in « thi-Pi'fold 

inamicf. 

Thoy TAKE UATKRIAL FOB XOITRISUUENT FUOM TUB OHGANISX of iUwIf 

seldom of very considemhle moment, Skiii-piirattit«« and tape-woriiiK sehlnm 
act iu this way, tbe thread worms only by their great niniibei-s; tli^a 
arifiH HtgiiH (if uiirutiiia and nervotia RrniptrOiua. But tho nnr/it/ftu,tomHin 
diUKlrnaU c(iu«:s ilirongh thi^ blood which It wiintit ft>r it,s uniiiishiiipnt, 
atill morn, however, throuj^li thn hipmon-hi^ foUuwiug it« bitc-n, tlie ko- 
eall('<l Kgyptian chltirosis, ttc. 

Far nir>i-(r iiiiportatit aru the VKCllANtCAl. INJTRIRS due to |uinutttt% 
Tj(r;<er piirnsites, us well as iiiimor»iis suiall ones, lyinf? in heii|i^ cnuoa 
pi"cs.sure and. finnlly, atrtpphy of the iieigliboring lissiifH; thus cysticeivi ia 
Beveral loewlitieH, c. y., the brain and the eyu, ctbiiiococeus in the liver, 
etc. ; tricliitia in the Kiiim^kis. In consequence of pressm-e, or, at tlifl same 
tinif*) nf tttiTtpIiT, sometimes no disturbances of function arinu {r. «/., in tlw 
not too nunnirons cysticerci and tncliina* of the muAc1e&), sometiiues th<we 
arise which, with regard to the position of the affected part i*e»pt>cliug the 
whole organiwa, arc of various importance ; by means of cysticTrci in thi.» 
brain, hoiiiettnics cmivul>sinns, HomeiinieH palnie-H, Mmietinie* rumlnl di»- 
turbimcea arise ; thioujjh those in the cyo-lmtl, blindnetts; th)Y>ni>lt echinu- 
coccu'* of the liver, suppreHsion of the specific function of tlit* oi^n; 
thr»->ugh large nniiilx'r« of trieliirue in the nuiseleK, timbility to muvn^ etc. 
Farther on, there may arise secondary tiiHtiiri»iU'.?e« of the circMla*ioa, 
iuHutDniatiotiR (if, g.^ of the aerous nieiultranes), pu»- forma liona in tho 
neighboring tissues, ruptures, siitu 'times with (he coub^ntH pasNiii^ into tho 
intestines, or outward, pnrticvilarly tlirough the abiloniiual walls, rtc., 
espwiaily witli tho ecliinococcus. Tlie panp^itea in tht; camaU contract thrir 
calibre; acute atenomti uf the intcstiunl canal may arise in coiLsequemv of 
numetXMin coiled tli rend worms; icterus, in oonsequencc of t)ie thnrnd- 
wonu iu the larger gall-ducta. Tliey give rise to catarrh and hutmorrhage, 
perhaps even to ulceration of the alfected muccins membrane {la'uia, threaii- 
wovms, etc.) ; thereupon ari»e disurdurji of digetition, with inuludicii both 
local and geuei'al, 




rUuTi ZUA. 



Ill 



jiSiially, tlie pam8it«s act [SJItrioiisly by thbir motion and MinBATros, 
•nd thus cause sometimes ]»auiK of various kiiuta, kmcIi hs y&iiw in thr musclus, 
itching of t-lie skin, coli»?H, Ihu Utti»i' particulurlv in tho fnatiii)» stiiu*, which 
cUrectly or hy rullcx action, mtiy give nse U) foi-tlier trouhlc (ilch-tnito, 
Ufi'^-wnrinK, oxymifi) ; Rometimes iHTfiuiitiun Hiid t'opture of the iQlmhited 
oi-pnnK (echiuoix-ecuB, [Krh^ifK hI«o thintil woi-ihr). 

AI! these coniUtinns air only piirtly kjiowii with i-t^siH-ct to nuin, liiit art» 
«ell ehtjihliKhetl tliiuugli exi>eiinients on animals. They aru bout known 
conw-'iiiiiig the itch-mite and trichiija. 

The iiVurT*t.Hs OP PAKAH1TE8 sTc ill oiily a few cAfl«>8(ttch-mitR, trichiiia) 

fechnnK-ttn-isli<.■, that it is »^fe to iiinke a dingTiOKifi fi-oiii ihrn). In iiiOHt 
\en tlif dt_-in<>iistr»tion riiUHl be objfctivc. In these it ia fumihhrd either 
by the r&umiiiation of the cxoivtA, wsfM-ciuHy of the stooU, »onietiine» of 
animala which have come nwuy piilirt) (thri'uiJ and rouiid woiiiiji, trichina), 
bom^tiuiMi of articulations (t«iH' womin) or ova (tliread and routid woriiin, 
bi'thrU*ctfihfdus tatus)^ or by the examiimtion of tlie Kkin (itc)i-initc), with 
th»? iusi»t«d wye if necesaary, of the eye (cysticercus). or hy examination 
after pro^ioutt operatioiLS for obtaining the pai'usite (Irichiua, cyaticei'cus), 
or less certainly by palpitation and percuii«iuti (echinocuccua). 

(In the foUowtng spediU oontiidenition of pamAities nse hu been made of Claus^ 
Grth. d. Zooi^ IbWI, and Lkuckaiit'm wiyik on PanMitcn}. 



^^ 1. Protozoa. 

Creatui-es of amuU size and bimple conHtniclion, without »?parnte ctdlular 
OT;g»nH anti lisMitvij on the liniitM of aiiiiuitl lift^, witli jirepaiidemtiiig h^^hxiimI 
propH^tion. 

In the raoat aimple instance, the whole body ia a little masa of fornilejw 
albuminoid Rubstance, HO-cal!<-d HAitronK> whoM' contractility in lindted hy 
no outer firm mi^mbrHne, M'hii^h Kouietiim^Htiends out tntiilv fiiHHcl pixijeetionHj 
which when frrrmed, are dniwn in again; Kninetimn^, with more glntiuoiin 
consitttency of the parts, it sends "iit a nuinl>er of hfiir-like nidintions and 
filuJoeutB — Am<eji.i. Nom-ifilinient takes place hy llio gradual enfolding or 
presHing in of foj-eign bmlitis ut any point v( the perii)bery, 

^tt. Class: Riiizopoda. 

^Protozoa without enveloping membrane, whose panmcbyma sencU forth 
procenutee fpH«-uHopoitia) luid dniws ilp'tn in ; generally possessing a eecreti- 
tious cnlctiix*otis covering or HiUceouiii frauiewurk. 

FnaAMtXtFERA. 

Rhinipiwln whitrh arc pnrtly naknl . portly provtdtMl with shpllo which nonrfirt almnjit 
Mitjrrtj at rlmlk, line] fur the moKt piirt nn; pierced at tho e^eim of dm iisvudi>['Oilia 
by fine iH>reH. 

A ufiinhei of oryanisms heloDpinff to thin olnss are, aecordinff to otbcnis of Tegw- 
table tiatuic— ^. t/, timnJnt di£tutn«^ arvtila, diffugin, etc. 

2. Class: I^fi'SORIa. 

Protozoa of deteruiineti form with an exterior {cvtinila) covered with 
rilia, with a month and jmlnating vacuola (t. e., clear, niohtly round cavitiea, 
filled with litjuid, whieli cojitmcl iind then diwipimir, but giadually be- 
conte linible again, and enlarge to their oiiginal Hi/.e, and which ure moi^tly 
connected with veiweMike lacunic) ; with male and feaiale sexual urgiini>, 
but, mostly asexuoli propagating by gemmation and fiaaiou. 



PROTOZOA. 

rASCiT.Y ; HETKnoTRTcn*. Thc body, orcr it* wbolc rarface, {* tMcWy eoYerH 
wtbh cilia, wliich ar« ofU-n amLtigeil in lutigitiuUchl rowK, DtHidi'S ubout tht- mouth, 
ifi a Hurrouniiiniij ton^ of Rtronptr rilia iStkis), 

Balantihum. On tha left m\e ot the lon^ritatlina] axU oT the otnl body li a 
bnooal aperture provided with )oii),'cr cilJa. 

TlALVNTTDiru COM, (mai.m^en ) Very comtnon parulte ot ihe xcaUim of lioei, 
a few timtti fiiiind iri thr? liirj;o iiite<>tiiit: of man. 

An i'siiu(i:<fi!:itui.f: are distingutshccl four different forniR of ■iiimal 
purasiteH, which in the body uf thtsir hcitst iiiay, by their (.'nunnous acciimu- 
lationfi, iiuhice morhid conditions: 1. ]N!nr(>H|>crtnur of fii*b«'»; 2. the no* 
oallc^l psoiidonftvictdla of worms, etc. (both aiv pronounced to be tJio jjjraB- 
uUr germs of gi<!f;ariaa> ; to iia tUey are of no iutcrfbi) ; 3. the so-caUed 
oval or globular jtsoroapermiie ; 4. the so-called MteoL-heiiua pouches. 

The globular pBoroepprmisB were finit found hy J. Mrr.l.Kn iArrh., IB-tl, p. 477, 
etc.1. tlion by Hakb {A trr*i(. m virir... mpUl, f-tc. IH-Wl a-nd N.\mf. iMiitL An-Jt., 
184'(. p. 209) in tbc liver of rabbiu. by IUmar {Di'tgnmt-. etc, I'ntrrs., iy4-"»>. Jn th« 
intesUnca of rabbits. LlF.Bl':KKfnN ^X'i^n. c/c FAaiil. Jivj/nle, tk. Jtrii/.. I»54k ami 
Stirpa ( Vifch. ArfJi., ISlWi, XXXII,. p, 132} firat oonjectured their ri'lalioii to g-re- 
gariiiw. OotiRult aljw Ki.Kiw (/'/., l«.)il. XVf., p. iKS). Waldenburo [lb.. XL . p. 
4!!.')) still more positively fixed their cliaract«'r as tbat of pKortwpuniiin SeB also Vllt- 
cuow (AreJi. XLIll., p. 54S. etc.). Wliyllv difforcnt vicwN are hold by UoLurP. II. 
JosiiB. La.nh (//a, XLIV., p. 2tH'>. Accordiuff to lUiUyvy {Afai. ('rr.fnilf'l . IWiH. No. 
21, and I'irc/i. Ardi.. XLIII , p. .112) ibtrMt aiwi the Uirgor luialogiMis forms wilbio and 
near the mmicleH of thc tiumth in flUiHip arv not pHoroxpunu {Kiuchcit, but nccnmola- 
liona of iymph-cwrpusolen, Tbow lympti-cnrjmsdun wander out from tht itfrimjf' 
nuni intrmuih [nto the initw?(ilar titirc>« and. M-hcn they hare aggregated into mawtw, 
they become Kiirrounded by an enveloping membrane. 

Aoconling to BtMEK [^l-eb. if. }^>rtitipermmi iM.tr., 1H70) itaorospennifB are not 
granular germa of gregorioai, Imt gregarlnao at ruat. from wbiuh by [olilin^ the pru- 
per ptoruspermia arise. The sickle-shaped aniumlcule. the pregarinu, becomts 
within or wUhiiut tbe niothet vMJole. an amrobotd cell. Tho latter grows, free or 
withm nn (^j^idheliitl r(-ll, and ftnally iMHToma u Ho-callcd naked pnoronperin. t. p., a 
rouud u[ uTol gruniilnr body with ur without uuulcux. It tieuomea encapsuKvl ; with- 
in the tnrntt^'^ri.'ut cnpftiilo. there apiwan yrt a xeound ahcath. The uapwilar contest 
contmcts into a Kniall gloViule, which diviilcH into ^mall farrowed ^obnlea. Prom 
thcflo ari*^ the yonng trrpjCflrinaB. The capsiilo buritt. and the frrrgarinte lieeoroc 
free. Grftyaritiiu or amusboj nriding Ihorvfrom frenucntly enter the eiilthtdiiU ucUfl 
of tbe inteBtines, there to devt-lop, and ibeuce to jjajw iuto other jtaria of U»e bntly, 
especially the liver. S«e abw Urvoi.TA {/t. metiiea t^terin., Maruh, 1H(J'.>). 

in nion pdortwpennitc have been Found in the intPQtinm by KJEl.l.ltF.ltn < \'iniiow 
Areh..X\\\\., p. 52T) and Linkh, in th*" liver by Gl'iii.kr (fJnz. nttJi., JS-^S, p <St1), 
Dkkmi.kr iLllTKAllT, X*iV meu»eM. I'urat. I., p, 740h in the kidneys nod in tho 
orine by Lindkuann (LKtJrKAliT. /ft., j) 74J.| 

Thij no rslletj MiKst:nKic's pouchfia or RArSKY'« ci>rpnBcl«i in thc muKoU^ of hnga, 
etc., con«int of n dark granular matai. 1 mm. and nmn.' in niw, of uvid fiinu. %vhivh. 
sniTOunded by a transparent capsule, aiipcors imbedded within a primitive mujfcle- 
buudlv, and givL-s rise ui n Kltght o\'ul protrusion. They aomettmee look like trichina 
capAuJt-H, Imt novur ctiuLoiii a worm. 

Kl.Ani':i.i.\T.'K. Org»ni«uij« without a mouth, ftlmilar to thc inftu»aria. who«ie motor 
organs ara forroed ol many losb-Uke cUia, niruly, at the same lime, t>y ii tcmtw- 
rary BorieB of cilia. 

Fam. Monadisa. With round or oval transparent bodies, devoid of d[»tinL-t orgu- 
iufctiou. wlib a Kingle or only a few glittering, whip like hairs on the nitfcrlor tsx- 
tromity. 

Cp.iicoMON \ia. iDcrAitnrN.) With a caudal filament, and. for the moHi part, with 
a single long and ttiin lafth. 

CKifroMo.NAH j.NTKsrtNAMs. (Laubl.) Fonnd by Dfjardis and otlwn in tlw 
st'JolH of typhoiil fever and cholera, by LAUni. ou the catarrhal mncoub uiemhnuie 
of children, 

0F.HCO^fn><,\H rntK.\Hivi«, ^Hav^ai, ) In the urine in cholera, in alkntine. altio- 
miuoua urini:'. 




WOKSC9. 



113 



CmomHOCAS ULtAX^ (EsKCXBEitc. ) Ot»erT«d hj Vtsjyi. oo the dirty snrfaca 
oCiitaam. 

TatcsoMosAt, iDoonl ) Differ* from OitximouaB in hftTing Bi>m« dwut etUft. ooe, 
tvo. or t2ki«« be*r tlhc uiXerMr Uah. 

TRicnoHONA* TA«iSALi«, (Doipce.) Teiy comtaon in bkawabau of the Tngioo, 
capvciallj in ibe yrikf iA . •tnngl; aeiA vagmal mootu. 

II. Veiimbs. worms. 

lAtefmlljr ^ntoptrical animaUf with non-artlculoled bodini, compowd of 
CTirrerf, or faomogeneoas •pgments without urliculate ap|M>iiiJagm (1^^)> 
The emlwyo is gpncr&lly formed br a tnuiafordiatiou of Uir wholo yolky 
wilbouc pTffrioiu |>rimitive fciltlft. 

The dan eptudjitji of » layer of celis anil niostlr of h KUi>orficial hooiogo- 
Mous cbititi layer, wliich coQN>titute3 one of the secretitioua variotwlr strong 
culimlu. Th** flpmia, tlin>i)g)i tliu atlactiiiiHtit of the longiradiitnl, and often 
also of tiie transvere*) tDtiB^*Iets becoui*^ a cutaneous muscular ]>auch, tlio most 
iuportaiit organ uf mut'iuu. Often there is au entire absence of append- 
agea. When they exiAl, tbey eon>ii)4t cithor of tip|mratus of pi-yheusion 
(micken and HiiiiTeuns hiwilcH), or brihtlv tnfts. Soiix'tinifK gilli arn found, 
viibout which rv«piration i& carrifd on by ntcnnH (if the skin. 'Hn-ir abode 
is in wattrr or in uioiat loctilitie-a ; their motion is gv^iieiidly slow. Be- 
sides worms withtiut intestinal canul, blood, and nerrons srstetns, tlirre nro 
found oihtrrH which puaaess theae itppanttus in highest ]K*rrfClion. 'Hir* or- 
gan of excrviinn it. the so-cnllwl water-vefUM-l M'su-m, i. f., u synnnetrienllj' 
dividi-d canal of finer or c<«r!ior cAlilx'r, tilli^<l with a wntery, tuonietiiuva 
granuUr lit)uid, and Urrminating cxU*mally by a Ringle or multiple urillee. 
" the moat part the very importiint orgnna of g«nenitiaii, inalo and fe- 
!. are srparate in dilft-rcnt individuals; sometimrs tlicy are unllotl in 
name body. Their dovclojiment ia, as a nde, connected with a iiieia* 
! mofpbosifl. To worms belong the must nuuieroua and most doiigei'uas of 
buruan paraaites. They live rxolusively in the iuternol orgaiia. 

^^L lll^Lass: Pi^Tt-nEs, Phtykuiia, Flat Worms. 

B^WonnB with huiliei more cir less (luttened, whutte opjH'udnges, when prw- 
t'ot, cmimst mostly uf suckera and hooks. They are mostly hermiiphro- 
L Nearly alwayM, at h'ast tirmporarily, panwitic. Many are without 
nth, iutestintAi, and nuus, no thot the uourishnieut Is takou up thi-ough 
t BorUcv of ibo body. 

kiRflT Ohdkr : Cf!itodkr, Tape-wohmb. 
ong. articulatetl, Bat woniut M-ithout mouth and inteatinnl canal, with 
tim for preheuffion on the anterior pxiremity. 
he anterirtr part h'SHetifl in size and presents a button-like or globular 
nwelUng. the firi-call(>d tapk-wohm itE-iP, which, in diir»<roiil wuyM, hi>ar8 vari- 
ous or^iarts of prBhensiun. The tliinuer portion of tln> body inuuedintely 
behind ih'' heail.tln? so-called NEcK, shows gcnendly at Home distance from the 
brad tli*' first marks of an articulation. The fii-st yet indi>(tiuct rings, fai*- 
thcr on aliortun and couKtitute the joints, then, in continuous f^ucccssjou 
tb<>»* leniithon and broaden, and at a greater diatanco from the head be- 
come flburply defined und distinct from ouc another. At the {xtateiioi' 
extremity the nrtictihitiuns reach their grealent circumfen-nce, often nepa- 
.tale from tin* body of the worm, and live a long time inilKpeudently aa 
ftUid ao-udled l*HUOLomu£a. Tlic tape-worm is uUo looked upon aa a 



T\PK*"W0TrM9. 



chain of tinimals, cousLsliiig of the Hrliculations, the proglotfid'^s, Oie 
indiviiliml, iin<l the Bcximl Hiiiniiil. Thrwe rlt^-velop by meaiiH of aliHi-naw 
jiJfMienition by a procnas iif building, on tlie penr-shapod parent, the liruid 
(Si'DLEX), and liiuig ihci-coii together U* form a long and i-ilibuiid-lik» 
colony (comiuonlv called tapr-toorm). The piimnchynia of tho Iwidy, tm- 
closed by a temler skin and HuttCHlain'ons mtiaclos, is a cellular eount^ttvA 
tissue, which, in it« pi?riphp)% onjifrially ou the head, inctobes Kroall 
chalky concretions, vi all parts, the mniiticatione of WHtor-vi-nsel Kyst^m, 
and in the central parts, the sexual or^tis. Org&uH of wnsc un* wautiug. 
Liki^wiHt! iM there no <Iig»'Mtiv« cHual : the nutritive lii^uid ready for abMiprb- 
tion entem by endosuKiKts diivotly into tho parenchyma of the Kwly throuijh 
the whole outer sinfare. The wafer- vi'Kficl aysiem, [laiwing ihiuu^li the 
whole length of the body, wervtw as the apparatu-i for ^xCR^tiun. Tht-re art' 
at uioKt two ur four Ioti}'iti)dirml caiialH, laterally Kitiiated, which, in the 
hfw.1, eoinmunicate witli one another by h'an^vei'He loops; ivlso in the single 
articulations transverse anastomoses exist, and they empty thi-ir cont*'ntik 
thi-ough a [Ktre in the end m-^nnent. Kver>' segment of h ia|»e-wonn hafr 
ilH &pctMaI lualr and ffjiiiale organs of genenition. The iiiaU; p<M-ti<j« conatiKtA 
of numerous pear-shapf^d testicular papilla* whoso pedicles Iwid into a oom- 
uion aecretory duet. The winding cud of this lies in a rouECular aac (rirrw*- 
i}eiitfl), and may jiroject out of it aa a curl through the o|H->uiug uf the 
generative organs, 'llie female genitals conaiai of (Ui ovary, uterus, semi- 
nal vesicle and vagina, which la^t, for the most part, beneath the ojiening 
of the male organs, usmilly empties ext^-riorly in a common driiin. WiUi 
t ha great ineream* of the artienlationK and their diKtancn front the bead, 
t}iO perf(;ction of the sexual ap]mnttua incivases gi:a<Iua!ly from the anterior 
to the posterior extremity of the wonn. The poshtrior segmenla ripe for 
separation aro the first to [wrft^t their wliole sexual (iov.iluputent. All 
tape-worms aro ovi(>aroua ; but the embtyo is often developwl in tho egg 
witiiin the ntenis. 

Jiuman tape-wornia exhibit a complicate'! metamorphosis connected witK 
nlteninte g«^ieratiou. Llenerally the ova with the proglottides leave the in- 
testines of the tapi^worm beaivir (loan^, anfl are present on man\ire, plants, 
in water, etc., and are thence passively conveyed with the food into the 
Btfiiuach of an animal, rarely of man. After the aac of the ova bos 
been dw-ntroyed in thf new abiule by (he oprnition of the juic*?* of the 
stomach, the embryos l>eminiH fr>»e in the stomach, and by means of their four 
or six movable houklets bore through into tlio vessels uf tho fitumnch and 
intestine. Here they are driven along by the blood-oun-ent and ib.'[K>!tit«<] 
in the capillarim of thu most virions organs (liver, muscles, brain, etc). 
After th« loss of the booklets, the embryos, mostly eiicH]»sulate<l in a cyst of 
oonnectivo tissue, grow into larger vesicles, which consist of an external 
contractile parenchyma and watery contents. The veaicle gniduNlly be- 
comes tho cyst-worm. From its covering one {ryaticrTcns)^ or several 
{zchinocffvcui) nodular deprcasions grow into the interior, on the bottom of 
which is snpportiKl the avniamont of the tQ))e-worm^s bead, in form uf 
siickera and wrealJis of hooks. ThL->Ke depreused nodules turn outward, so 
that they appear as external appMiidag<'s of the cyst, presenting tho form 
and size of the taiio-woriii*K head wilJi more or less dcvcIo|>ed neck. It is 
necessary for the cyst-worm to ontei* the intCHtinal cainil of a new animal 
{t. p, uf man), loallow the bt^ul, afl«r its sepai'Ation from thu wall uf the cyst- 
body, to assume the comlition of a se^tually-tnatiu'e tape-wuiin. This traiis- 
ITortntion is passtvo thi-oughout, effV^ot«^ by means of the fmnl, eBpecialty by 
tlie UHO of tncaaled meat. The cyet is digested in tlie stumacli, and the bead 



« 



TXaTCtLAR TAPE-WORMS. 



115 



of Uio taj>e-worm is set freensasof^lcx ; the IntU-r entoi-s the Rmnll intcstiiiea, 
fuhti'ns itiM*lf bv meiiiiB of its pi^ehL'ti^ih* itinwirntus to thi? inwstiiial wiill, 
Aiitl tlrvfloiw hy grudiial fornuitiou of AfgiiieiitB into the body of u la|>e- 
woriH- 

All ta[>r woruis inhnliit |Ik> small iDteRtiiius^ while the c^'st-worniR mmy 
tlwfil in the liJOst viirious 'irgnUS. 

FAM. : T.EXIAn.K. 

The ])eur-Hhu]iu4 ur conoiJal heiul benre four rouud suckers with powerful 
iniisrnUr appBratim. Hotween the snrkei-s is commonly (ilaceil on tht- nd- 
vanct*d inrdiuji pai'tion of thn homl tin' rnnfrl/um, n »\u^le nr inanifnl.I urtuith 
ijf claw-ahapfd houlcB, fur whosp fi|H-(^iii] luution a ntiiscidur np|iiir»tu.s lit pro- 
%'idt}d. IVo sexual nppningK, utie uinlc iiiid uiie f^inalf, whiL-h liitlt-r ftervcx 
only for coition. Thpi ovn i-aii Iki-oiih* fi'ev only ilirucigh tho pro^lotttdi*K, 
hince the utt-rus has no 8|>i'einl »»|<t-ning. Tlio pro^h-ttiiii-st mv di?'iinctly 
sepRTiite fioiii oiH' another, in tUo pi'ifeili'tl stdlo for tliu iiuwt. pnH lunger 
UiAti liroail, and ant coinniunly providtsl vitli dexuttl u[h.'uU)}^ u^k>u tbo bur- 
ner. 

X. YISICULAH TAl'K-WriltMS: — lV8Tlr.«. 

Most arc of conMiderahlc mzc. Tiii> h'jud only rarely unarmed (tdcnia 
nifdioutnL-lhita) olht^rwiMo piY^vidud Vkith ii Icnlicnlar, Hlightly pruiutnent 
rost^lum and a circle of hooks. Be^ideii the clawji, the hooks hiivt* two 
strobj; projections from the rootB, the sliorler one aotenor, the luugei* 
(in«t<?rior. llie proglottides hw in the pt'rfeet 8tat«, elongatetl oval. 
Tlie middle etemof tho utorua jj^ivesotf autiniWr of ramifyiiig Kidv-hrHiichea. 
Tho npemngs of tho ar^xual upi>ariitu8 are on tho hoitler, rcgidarly altcniuto, 
iw>nieti[n<-8 to tho right, wnieiinies to the left. The ova have a (inu and 
brnwi) bhelL 'lite eiuliryonal lioukit are short and Ihiu, 

0. vesictTLAB TAi'E-woitMii, whoMe headti are formed in the embryonaJ 
state (ynbgc-n. ('ytt-itnynift^ — Lkuckakt). 

T.eKTA BOLIITM, (LIXX.) 

Inhabits the snuiU inU'Ktiuca. Occurs more often, singly ; less frequently, 
several are togetlier ; very rarely, numbering from ten to forty and over. 
In thif dpvelii|HMl state is UKually from twf> to three iin'tres long, unci itH 
progloltnti'u lU nun, long, anil ti nun. broivl. The h<>ad bt of the Mze of 
the head of a pin and globuhir, with tolerably ))rnmineiit snekerH. The 
vorti^x is not iufreqnently pi^ieuted bluek, and bears a inuderately large 
ro»tellnni with alKiut Iwonty-isix hooks, lieyond the head follows » neck, 
almost an ineh long, filamentona luid lincly articulate. In the Itcginning 
the aitir'ulations are short, but their length gra^lualiy increases, so slowly 
jiowerer, that they first assume the quadratic foim at a flistance of one 
metre htehtod the head. Not far beyond begin ilie inat.uiv arlieul.itionH. The 
mature proglottides whieh come nil' only with the eacreuient, at Utat 
in abuut tliree to thn;e imd a half nmiiths after infection (in ditfereiit jw-'r- 
8nns, in im-gitlar tiumbL-|->: find limes), are longer tliun bmail, with rnutiiltfl 
c<jrn<*n', like pinnpkin seeds. The o]H*iiingK for the wxnal organs lie behind 
the iniddlf . The uternn jionwssea fniin seven to tt'u side bninches which 
divide into a varying nuiuiier of dentute<l branches. Tlie ova are nearly 
TY>nud and have a thick shell. 

The rV8T-woi(M [ryfticercH* cfttti/owe) belonging to this species has an 
««j;edal preferuDC* for the muscles of the hc^, but is found also iii otlar 




TWrnOULkB TAPE'-WORMS. 

)jlui-:«!ii and in utliPi* aniniiils, nehloiu in tlic u{k% dog, dvuv, rat, etc. In Timik it 
IK luund most freijuetitly in tbo JutLTiiiiiMcnlHr iiml 8iil>out«iieoua connective 
liiwu**, aiiiJ in the brain, more rarely in tlio eye, lii'-Hrt, liinpt, liver, kidneys, 
iiieuinges nf the hrnin, and lym|ihatic gUnds, very rarely in the spleen and 
liones. Its occnrrenco in tuiinials is usunlly in mosseH. In uiuj it is fniind 
Knmutiinea bingle ; aonietiirieH several art; fuund, rarely in vast ntuulfers. 
The Lnil-evHt hua »n invgnlur, niodemlo »ize, and in the niuseles, a tnmi- 
VL'raely elli|>tical form with tlie longest diuiuet«r in tUo dii-cctiou of the 
coitme of the (ihreK; in ooft organs (uyc-chanibers, vitreous, ventricles uf 
the hroiii) it ix round. The full development of thti panutite continuw 
two and n half months ; it^t life, from thretj to ftlx years. 

The derivatioD of t^uia soUvm from Iho common moaiile-panMlt« of ffwin« follovrs 
imt odI^ from the entire agreement in tlie formation of the Iiead and form of the 
lirKik^. tmt ift uUd ex(i' rimentally provoii, l>y the development of the eyitic^tw eiUu' 
UnHf out of the ora of f. «"' / olno, by tht; growth of thn Cape-wonu in tbu inteiitinal 
eanal of man. from the <*.V'*^''^- ("ril. iKl^cillOMKiKTKn). 

Oacti ] found cystioervi in httce nuinUun, in the uariier stages of devcloiimcut, in 
tbo Uvcr of a tubeiculoua loau 80 yean old. 

T.«NrA MEDHX^ASELUTA, (Kt'rHBNMKISTKR.) 

Hur|>a»Ri.'» the (a'liia tiolinm, not utily in length (by one meter), but also 
in breadth and thiekneMt, as well ns in the nize of the pi-(iglottidi>8. Vav- 
ticularly striking is the breadth of the iuinntture F^egmontft. wliich som«- 
timi*8 i-eachcs fi-om 12 to 14 mm., and, helund the head, they rarely 
diminish so pi-eceptibJy an in t. sol. 'Hie length of the seguieiila iucmiBes 
mueh moro blowly than in tlie latter. The head, of considerable Jtute, la 
without a circle of liooks aii<I ro-stellum, with a Hat vortex, and four hirj^, 
extremely iwwerfiil tiuckers, which are u.sually Hurrounde<l by n bonier of 
bhiek pigment. The con»plete dirvelupinent of the aexnal nrgans is found 
■is in t. sol., near tlie 4.'i(>tli sc^meiit, wliihi' thr* proglottides n-jich nmtuiity 
in only from 3t>0 to 400 j^mentsi farther. "Vha ova have a thick fihell and 
Bi'e mostly oval. The nteriis is ehnract«rized by the number (20-35) of it« 
lateral branches, which lie close liy tlie side of on« another, and inHt^rad of 
by dendritic brandling, they are known by their dichntomuus division. 
If, ashore very often hup|N.*nti, the segments come away spontaneoiialy, they 
are nsually without ova and ftUruuken, but Btiil alwaya uf oon&iderable 8i?<- 
and thickiieaH. 

llie cYsr-woRM of this species inhabits the musolett, especially alao ih-- 
h^art and internal organs of cattle ; it is nimilar to tlie nieiihleH of swiue, 
but HiaalkT and without circlets of hooks. It does uot yet appvar to have 
been fi.'und in nian. 

T-USIA fCVSTICERCL'aJ ACAHTUOTRIAS, (WRINl.AND.) 

The TCflicles of this tapeworm, which Ixatc hitherto niona been known, Htc likt: 
the CffAticerftta CfHniont; which it closely refcmhleii. in the nraadea, saliciitaneons 
oonntHitive tiiwuH. and braiu of luan. The hook>apiiaratiu ootudstB of a triple circle 
of (jnit'V 8leod< r ulaws. 

•sxsi^K MAROiXATA, fBATSCH) : txiim.eyat UtiuieoBi 

The matnreta-nite, which are found in tho doe and wolf, bear a r««<!Uibtaxioe to 
tonta Milium. Tlio larva if^ynt. tfnniffMui) al>i<iejt «i>]MM-.t»ny in the cimt'iitum. \tm 
froi)Ut!i)tly ill thu li%-er uf th« ruminannt and ku-iul-, ntul orcHHioualljr in that of miui 
{rifftif. finrrriilix of auiboni). It i* oval, and of coneiikTable duo. In the folly 
grown lurvB. one extremity of the Tcsiclo is drawn oat iulo a neck like pToccM of 
greaUir or lesa hnigth, which proccM routaios a solid tapR-worm, and kurrounds it 




VESICULAR TAPE-WOUMS. 117 

IQm ft «hcnth, when hotli are dmwn into the Liit«ri>tr of the reilule. The jMstcHoT 
extrciQJtjr groWK ribaiKl-Ukc, and linnpt loone in tlie vesicle. 

b. CvsT-TArs-woiuis, vrhoflo heads bud forth froin the eiubrji'Qmc CA|>ttule« 
uUnclied to the inner surface of the vveicle. 

T^ssrtA Bcnixofxtcrus, (t. sikbold.) 

Tlio worm, three to four lum. long, conMHts of only three or four Rpg- 
niimtA, thf luMt of which, at iii»tiirity, excL-rds in bulk the whole remaining 
hotly, Tlie thirty or forty huokleln hnve coai-se prt'Cessw lit their Ita^te, and 
Hre jklaceil on a toloruhly ]trotuin<-nt roKlcUuni. It liv^A in ntitiilHtni in the 
inteatinal cRnul of tho ditg {^not in mini). 

Th«> young tilAtc of Lhi.s tn«uiit, the Hu-cnllttd KmiNomciTa, forntti a very 

funftidoniblir, almost tuotioulem veKiele, whidi connistA of n litiniiiflteil cuticle, 

•ud of the underlying cclluhir |iAn.*nchyinutouii layer, H\nm the inner BiirfHi^e 

of which numerous liltli* UcwU luifl forth in vosiclfta of the size of a millet 

aeeU. Not infrwinently the veMeh-s incrcaae by n budding procesH, out- 

Ward or iuwani, tJiiiM b«iug tmnflfonned into a compound »Y»t<*>" of hirger 

mid diuiiller TeNtdes indoKed one within thn other (diutghter, gmnil- 

<l»tight«r- etc., vefiich>9i), all of which in turn give rise to h h<4td. In thift 

form the vwiclen lln^ found in niiui and cattle (so-called echinoc. /lominifiy a. 

<Mitricipnnrnjl, t. cntioffrnu$^ h. ht/tt'tluUnnm of the authors)* whiln the retnain- 

ing ruminants, swin« nnd a|>e«, for tiie most |>art harbor Kingle vetiicIeK, or 

ilmst' which ineiraj^! ifxogenmisly (wj-adled rffiiri*": rx^f^'lnonnn^ a. tvo- 

yt-ttv.0y9. </ranvlogtt4j a. ncoliciparintm ot the authoi*s). Hie favorite ubtvdu 

uT the eehiuococcuH ia the liver ill ntau, yet it in occattiojudly found ilk 

alutoftt every organ (Hubcutuueons cellular tissue, niusolcM, |M«ritonrinn, kid- 

iii-y, lungs, »ple»>n, nerve-centres, l)ones, hesirt, orbit and eye, thjToid, ele. ), 

Th»" f'hitif^. ffraftuft^ug i« found most tiftcn in the epiploon, in tlio parietal 

laivor of the peiib-ineum and in the bones, less ufK-n in the liver, Hpleen, 

luogM, etc ; the #rAi»)or. hyfaiitlofcutty pi-eferably in the liver, Hplet-n, lungii, 

and hulxnitaneonH et^lulur ti-HHue; ft4)ln^tinll^s two fiirnis occur iii the saum 

body and oven closely united — generally a single echiiioe<Mreim (»nly is 

found ; many occur in varions cirgnn», the liver, hnwevt*r, being UKiially tliH 

principal liubitat. 

• 
AcourdinK toLEDCKART. the diRtlncUon botweea echinoenccttt cMritiiMtrka* uul t. 
'rUH4 it hindiuuiiiibltt, ainoc both euiuc from tttnui tfhitt'f^eua (KnARRE's 
iDjfcn aiwi Ulaml; N'At;«\'N'» lilxp<iriment«, Arch, /. Atutt. /*Ay«. «. trww, Mrd. 

Tbn e<;hino<'oocns of the Ilvcr occaplos any part of the orpan. In half nf the oaws 
nf (!chini.»cxi(*);uK of tlie livor wlilub I hove BOca. it hnd become effete in Tarioo* »t«j;i'i8. 
Tvi<>e in the |rn-at«r onic-iitam I found muvnljle ecln'uococnl. am;] on all the surface* 
betwt>4Mi the U;(>r«. vhlfliiij^' effete eolitnoc.. of the sice of a cherry. Consult also 
VncitTKi., i'tJy. d, Vurk- e. EeMnot. im Knoehen-»y»icm dts Meii^Aeu, Brualau, 
1879. 

T'— '"■ — th of the echfnococcQB is mtwtly a slow one, continniDg. notinfreqnently, 
f' - -.OB haa bveu detcnnioed br cxjicriitKrnt, from the dia^icwia of ncc«HNi> 

bi- ' ' ■ecj of iuternnl orjcann. as well na i.-»peeiall^ frum their iireiH:iiwi in the 

f>ut>cuuuit;inui ct^tliiltu' tikj-m-. An rr/iiufCirrtis li}ftUitMlii*'i», nearly a» Inr^ as a child's 
head at the tint* of npiimtinn, Mtiiat^'d lut entaneotmir betweroi the crcHt nf tbo iliitm 
and rihp of » man fotty-oiie year* old, had h*en nbAeired in his twelfth year having 
th« ahte of a moKket-ball. Tho jirowth was eomewhat quicker tn another similur 
ease. 

WhiJe the above-mentioned fatmi of ecbinocteeun always rcprcaeiit a vcKiuiihir 
body of roD^iderahlv Hite, the ito-culled multdoculur echiaococcun 'VlRCiiow) u 
alw«j* amaU, of the iue of a inUlet-8«fld, or, nt the most, of a pea. Observed from 



COMHON TAPIMVOBHS. 

thfi eu-Uest pcHixS of its rlevel0|)meut, it ut dutut fouuil to fonn « Hax^e reddft, bnt 
only a group of little veaitileH, wliiuli. Illr|;(^r tuiJ stiiitller ititt^rinix'jd, lie clow to ooc 
luiotlier iti uitiLKidt>raMe nuiuben, the mnallept pQrtiaii fornting hetubi, and ar« tfin- 
iKHJili.'ii in acommoii titromii. It hii« hitherto i>«3U olififrTtwl only in tho liver, wln-'rw 
it for thti irioAt pbft forniF. n roaml. linn txxiy from the Aizo of the flat to tliBt of u 
vhil^t'K h«!iil. whicb U cjuite easily dcjirived ot ibs covoritig. rosomhleit mn.ny (>o>loid 
tuiuorfi oaiuliini^d, mid, on thJA acOf>Diit. w.ix fnriiierly n!^;utli!d as alvcular This 
ecliiiKJCoccuM HhawM iu acuLioii. mutiy iimiill, miMiLly irrujpilzLr uivilint, sepanted frou 
oiia niintJier by a more nr lei«« thick (|iiatitity of uouncciive lUMue, wliioh oavities 
undone a tolvral^ty traiispareut gelntiniforin cacteuts. The naliKtaxice of the liver hai J 
theru ciitiivly disnppvarcd. Thti multiluouliu ccbinocoocuji in particular htiH a ] 
diapjaitiuii to ueutriil ulcfetaliuu. 

U[:m':u t ri'tv/j. Aie/u, Ibl'i, LIY. p. 'itiit) mlw a tuultUoculor cchiuococcus of tb« 
right hapm-ruual caiwule. 

B. coiuiON TAFK-woBMs: — Cystoidetc. 

Tbesa represeut, iu theii' early state, no [^ciilinr larvie. Ju tbe larvHl 
st&to (ay^livvi-coidiB) iiay uccnroiily in tliu culd-blf}oile«luuinmIft,oH|>eciatly iu- 
Vt'i'trbratea. (TLiis e. tj. the cysticeriioid of Ifttuur rlhitttcn^ *, eu^uimirina 
of ttif! (log live iu ihe lieu wtiioh infest dogs : tlio dug infi-cts liimst^If by 
eating tlicso lice.) With i-tfiijH'et to tbv ta|io-wort»M (butubelvcia, tbe small 
liixc of the lirud iind tht- ituiH'rfcct duvi'lopmuiit of the h(iolc'a]>{>Anitug are 
es|ieL-iuUy dt'sui'ving of uuticu. Clitiically, tiiuy are of luas tiupuitaiiiju tliau 
the cyst-t4ipe-woi'um. 

A. The promiuence ou tbe head is sopplied with a single circle of naall hooki. < 
The genitaJ port-s ate unii&tvral ; there is a i>uiaU uumbtr of vetdoiitar tcctiule» aJid ik| 
tui^i.' FL-crptuouluiu ou the nhort vugiiio. Vas dtifciuiiA without coiU. L't«ruN laryt^ f 
exLendiuf^' thioii^li tliu whole joiut. The oniitbon' iwosmoulh abell«, and coutaiu tuij 
umbryu witJi bu"j{« hooks. 

T.KNIA S.UiA, (V. 6IEDOLD.) 

8iniUl, about 2.5 cent. long. 0.5 mm. broad. The body anteriorly, Slomentoiu, 
but ticconitis iiuickly lurgcr near tbe middle. Cousistn of a bund aiid about one huu- 
drud m?frnientH. tho Iehc of which contain tM'enty to tbirijr muture ova. Ouch found 
by BlLUAitz in the duodenum ot a boy. 

T.SXIA ri.AVO-PC»CTATA, (WUINI.AND.) 

If 3it oeau long. The anterior half K\mn\*Xn of immature jointB, 0.2 to O-*) mm. loo^ 
and 1 mm. broad, which nhon* iMihind Lht- miildii; :t ipiilM hir;^ yt^llow K|H>t, tlip rL-crp- 
tAculum fllU-d with Hjwrm. In the remiiiiiLii!^' hulf the joinL* grow lo thr Itiigtb i»f 
1 mm. and breadth of 3 mm.. Ire Without yt-llow itpot>*. bat through the invvb-rato 
developraeut of the ova they are brownish -gny. The mature joints are tr^jiezoidal. 
ifou)Otiui<.ii almost trion^-^uliir. liinul, unknown. Foond onoe by WbihlahO in k 
child uiiiL'tf-'cu mouttiH old. 

R. Thu cluli-ahaped papilla i% provided with a multiple circle of aumll )iool:«, 
with u diftk-nhaped ba«e. Twi> |;euitit pores, opjit«ite to e»cb other. o|h;ii into a 
male and n female duoc. the latter of vbich, be^ea a receptacnlnra, [MUHeuaea aev- 
eral germ-fanning orgaiu. 

TXaiK ELLtPTICA. (BAT«IL) 

UHuaily in do({« nud cats, la tbe matoie atate, tTiO to 300 mm. lon^ and, lietitnd, 
1.5 to 2 mm. brmuL The anterior extremity of tbt^ body m ibiti, libkioi-ntAtiUf. with i 
thick head. The Hrst forty joint* arc short ; thereafter llioy stn-tiio oiiL so thiit the laAt ' 
are three or fonr times iont^cr than broad, and arc ko nearly ifu)Iat<4l from one nnoUict 
tliat tbe worm behind re»eud>ltr« a cbaiu. The moat mataie joints haw a reddish 
color fnmi the ova. 

PAH.: BOTiritio<EFHAi,in.E. 

Head datLcut'd ; it^i mu fuee perpendicular to tlio snrfaces of lUe eeriea ; pro- 
vided uQ its bordeiit with twg deep tistture-like suckers. ArticuluUoit of tlte 



COU:klON rAFE-WORMS. 



n9 



liody only iinpcifectly inui-ked. ProglottMes mostly brondtT thflu long. 
Tlii-oe j»eiiitttl ojK'iiuigs : uno iiinle aiul two female (*". *•-, one nppiiinj,' of the 
vajjitm >ui(l ouu of the iiteniK), im lliu iiii(l4l]e line of tlit; utKluiuiiiul surfuce 
uf t1ie ni'limliitidii. Thi; liui-il hturll, alrcjuly pruvidrd bf fure tht* ci)iiiiiii:u<;e- 
iiK-rit uf the fonuntioD of the tnibryo, it* provitlcd with a. lid tM> lliut the 
fuur ur MX'huoUeii einbryu may coiuu unt imlt^iHTiult'iitly, und lluKt itbuut 
(tev for a long tliue with the ht'lp of a ciliary covuting. 

BOTUBlOCCPilALLS, (SBEUSEK.) 

With a long-joinWd body and hoi>kleit8 head. The giMiitid pores are un 
tiib surface of ihc juiutK, ovi-r lhi< iitc-ruis near theii* anterior extremity. 
The mature uteriut huA tlie fonu of a i-osotte. 

BOTHRIOTEPHALUS LATfS, (BREMSER.) 

The most conMdei-able huuiiui tu^io-wotiu, which someliuies is from 5 to 
i nirtrt-K til h'ligth, ami tJirMi ci.>iim>>1'H of fiiiiii tlirt-o (.hoiiKand to four tbou- 
lud short anii bioatl juilittt. 'llie leti^th of the jotntH, with thu excc^^liuU 
bf the lufit, is .seldom inurt* tliiin 3.5 imii., wliih; tin; bit^uiUh at t\\*; iiijiMlu 
tdtially inL-reawR to 10 or 12 mm. In the latter half the brtadth diniin- 
bea, whiln tliu length inrri-iu<es, eo tliat the hist joints are nearly 
quare. Hem the lH)dy is tliin and Ilat, like a riband, esijccially on the 
udt^, wldle the central part of the single joints stand out in the fonn of 
sci t<lung)ited roll. The auterior end grows smaller and smaller until it at 
lust bee(iui»4 thread-like (0.0 mm.), so tint the bead, 2J} mm. long uud 1 
mm. broad, tei-ininatea in form of an ovul KWflliiig. The first mature ova 
are found at a distance of &00 nnu. behind the head. Tliu ivroglotlidcs are 
not ]iuiss*-tl away Mngly, hiit in lengtlis (from 2 to 4 feet), especially in 
Frbniary, March, October, and Nuvember. However, ot evei v 8t(K>l the 
rhamcteristic uva of the ta|»e-wurrn i>h*h iiway : thexd an- oval ; their nhells, 
transparent, coloiless uud single. Tho ova have a lid at one pole of each 
ovum, through which, when it is opened, the embryo slips out iuto the 
w(it«r. At tbo time of coming away, they are always in that st^e of de- 
vfiloprnnnt reprcbutiLed by folds of the yolk. The six-Uooked (-ndiryo, whii-h 
la eud>ediled iu on otiter etliiiLt^d meml}!!!!!^, is tirtit dcve]o|>ed sevcial 
uioiithii aft«r the dta havo been passed fit>m the intestines, and, indeed, iu 
fre-nh wat4T (i. «., river <u* seft-wat«r). It djlfera fnmi that of Uu' Tu'iiiiw by 
ita globular form, and by a firm membruue provided with thick cilia. 

TIk' hi'lftr. Uttttit is found nuly iu tbe western cantons of Switxerluiid iiud 
tho adjat^ent distticts of France-, iu the north weiilern and unithern jtroviuces 
of UuMtia, in Sweden and Pohuid, Il'mm freiiuently in lIoHaiid and Belgium, 
in single districts of eastei-u I*ni»ua and Pomeraniu, Rhenish llebse, iij<li- 
gPDous also iu ilouiburg, Berlin, i^ndon, etc. All these xouutries and 
localities are chni-actiTized by bodies of water ; they arc either bounded by 
ooMsts, ur luw couutrius with larger luras aud rivers. 

Acconlinir to KNocn ( HrcA. Arch , XXIV. p. 4i>3) the embrjros of tbe MAr. UavH 
are deTt^loiwHt (mm OTR to frefih water, in whioh ntsa they travel. In river water, 
wbk^ t-ftpedally in the wci>tcm proviDces and cities ot UuMia is Qiied tor drink, they 
areeonvuseil into tbe iatcucJiiiU canal of nnurmalH, and are then. &fu>r some tlnin, 
dev<-lii])>i) itUn MTxiiallj a\tiUUK tujic-wonriii. Tliv f4>u(1iii^ nf vurioux fiMhci* with tlin 
oT» nf lIhi tii't/tr. Ittt huv*» (Jetftrminwl nothint,' with c«rtai«t,v rpRiipfiting it« wxdex. 
\VhllM thf enibryod of Otnur twcorae the Beximlly mature tapo-worm only after jviwiiig 
tfaruiifrh tbe stAf^e of vesicle, the embryo of the fxdhr. is tnuisfurmed in the int'eKiinu 
into the •exuaily mature auimol without tbe preceding vesicular state. There is 



TBE3fATOinE8. 

Uiercfoie no doaH that the broad tape-wcinn in conveyed to inan by drinkiiig-w»t«f, 
aad for the moitt part in the tuxux of un embryo. 

BOTHBlOCBPnAl-rS COHDATIW, (LEUCKAItT.) 

^ot unliko the &. Uit'ui iti the foruintiuu uf itn jolutt. bnt much smaller. Tti« 
head, Bbortaud broad. li«an-»ihaped. vrith level moutlut. Ttie broad body, with lu 
mgmuati*, fuUon'K iminedmt^lir. which moreaMsa ao quickly that the outoior ptirt ol 
th« \Knly AMtuiiicN thu flbape of n Uuoet. Tho maliue •CKuienU art; from tliree to 
four mm. long; the hut larger tuid ahuoat aqiure. Itia found iu niirtiicmGroonliLtid. 

Rk(h>5D Oroeh: Tkekatodes, Suckch-wuhms. 

Pamsitic solitary ilat-wornis, with iiuirticulate loaf'Rhitped bodies; writh 
mouth, niid bifurcated lutestiual caiiHl witliout aiiuK; with KlMJouiiual pre- 
ben-silp a|»iHH-ittu9. 

With reiq>oot u> the basiH Biii>stinicf^, the skin and iqurcuIo)' appamtiifi 
hftve thy siuue rL-latii>u« m* in tho tujn.-wnriii. On the anterior [Kdi* uf the 
body is the tiiuuth, fur clic mttsl juirt ut thv bottmu of a suckor. Tltia leads 
into a muscular pharynx atid tKsojthiijjiis, wIiil-Ii iscontinuwl into thf alvuva 
blind iiitostine. Tlic cxcrotoi-}- ap{iui-utns cousists of a network of fine 
vesHeU, and two largur lateral Wniiichcs tliiMzharj'i]!}; on the posterior pole. 
They contain a tiipiid with ciatiulHt' coucretioiiK. The or|p^iiH nf pivheusion 
voi-y with the manner of lifn, t-ti?. Mulo and female organs un? inoatly 
uuitt'^d ill the Ixjdy of the hauu* iuiliviilual. Tlieir \torcs op^ni near th« 
middle line of the forepart of the surface ff the nUlomen. In the ovuries 
the ova a<xumulate in j;n*dt uuuilnM-H and complete tlie stage-H of etnbryo- 
forniatiou. All treniHttxlea dlaeliarge thrir ova. Tim young having c»m^|hh), 
in tho distomata go thiY>ugh a complicated altennit*; gonRration counocte4 
with metamoq>hoHis. The small contractile, nakud or citiatt'd emhryoa Kli|i 
out of tho ova which liav**. nrachiKl water, and, wandering iutlf[»L*iiHBuUy, 
seek a new anirual habitat, mostly snailfl. They pierce into their interior, 
loae their cilia, ami then dL-veloji inU» germcyBUt. Thest* aie thv parents of 
the i--KB<'Aiti.K, which ai-e |irovii|ed with a ruddcr-lik'i tail, and having 
esoapHil from the paiiMit cyni and iU hulntat, move ahout frfo by rr^'pinij 
or Hwiniuiing in wut^tr. They then enter a new ncpiatic aninutl (anails* 
worms, cialjs, Hsb), into the tissues of which they piorce thf-ir way, awl 
after the low of the tail, form about themselves a cyst. Thun have tha 
encysteilt young, sexK-as diNtooiaia ai-isen fiTiui the wiTaiiw; th».-. foriuor 
i-eceivod with the Hesh of their supporters into the stomach, and then«^ 
freed from their cyst, they enter utht-r oi-gana of another animal, whei"e they 
becouio sexually umtun*. Usually the various developtuent-Btages of the 
diatumata have also three HilTerent habitats. 



DISTOSCITJI, (RCDOLPm.) 

With two rnicken on the nntenor part of the body. Near the abdominal mdcezfl 
lia the genital poma. Tho iiiibniaJ urgatia of giineraTion oocupy the hUtd iMtrt of the 
body. 

A, Body broad and tftuf-Hhappil. ^^itb the forefuul ftromiupjit and beok'shapedL 
Tlio uterinfj coilii twifit iuU* a ruuiidvil body b<?)iUid the abdomiual suckur. Teatido* 
and intoatine brnncbed ; the former stroogiy dflrelope'l. 

DitrroM*;ii ubpaticum. i.tvER-rLrKB. 

Upon tbi> tolerably thiuk foccjiart of tho body (A to 5 mm.) follnn-s a flattened, 
elon^ted ural. larj^tr pnrt, whicb niiickly tini>ws tu n eonsidenible brradtb 1 13 mm.), 
tb«a Inwomi-Jt smaller, mid not iiifn^qm'utly rnavlivfi a It^agth of from 'i>~i t<i '■iH mm. 
The cHticiila (wars a gre-at number of »onIy spincH. SuvkeniHmalland w<t:ik. Between 
the two is the genital pore, out of which comos the thick, homy, xpirid ponis. The 
uterine coila appear aa a dark brovrn ^wt through the dirty-yellow Burfaca of the 




DlSTOMOf. 



121 



7*, doM liehinil the aMntninal sncker. AUa the liriuinhcN of thu mteAtinal caaikt 
oltcu »h<fw K blnckuh color. The Ihteral bortjcrs of tlie body poMeriorly vuntaiii tlia 

The (."vn/jtruc nf rlintmnum hej¥i(icum ntid UiHCnAittum are enenpsul&d mnet probA- 
Mv iu fr»*>i-waUir mutilf (jtlitjii.rbin), whirij if, e. g, ia nuLmby {ilaot^K, the> are oalea 
bv ithft^p. the latter bccomo in(e«t«l >iy them. 

The prrfAct ttUt. firjHttia/m iiibnbit« Diimeroiui herbirorona nuunmalH, eiipecialljr 
Bbf rp and other ramiuamB ; also tho horw, nnn, swine, rabbit. iK^uirr«l, etc , and, but 
Mliloin. man, Ita usual abude ia in tlie biliarj' ducla, esjiL-cifiUy the IftTgcst ; nnoh 
\tm ottva iQ the iiit<?»tiiie>i. in tbo interior or th«.' vcua cava, iiiid other parts of the 
vcnooA e^kteui. It (K-<.-iin< in tuan. f'>r Uie uuft purt, Hiu^'ly ot iti emnU utunbor, 
and ill ait tbv dutailtHi canfji whth the raii.se of <}liHtni(;iin^ the tlow of Ijile ; while in 
tn<«t dnm«Ktic tnainuiala thvy have i*oinetiini-a Irf^n found in kiicIi nttinhnnt that <li)a- 
L&tiou nf th« biliary dacta. ntrophj* of the Uvp.r, emaciation, drnjwy. and duath have 
nmlted (so-called liver-rot). AliwiDabAceMei of various parts of the body, tholiTor- 
flake ham beun fuuud in a few u-iaea. 

*; It-hly ninrp r<>(rTWarly formi'd, withoot branched inteatinal canal. Tlie uterine 
iNiilB Tenoh »o within lonj^flr or shorter dii>tflnco from the powterior I'lttroTnity of tho 
I'Odj, often to it. The bind part of the body fe moderately broud and HatteQed. 

OtoTuMtm ea.iMtJM, (Bcrk.) Once fouiid in Uie inteetinftl cttual. 

DraTOVUV iaxcbolatuu, (mrhlis.) 

Wth thin bodies from 8 to 9 mm. loni;. Both cxtremitiwi of the hody pobitod, 
the anterior mcnrq so, ho that tho poKterior Itnlf haH a greater bri>ti<:lth ('i-2.4 mm.}. 
The part bfiCween the two Mtirkem i>a»we-fl Bradiially into th« nthtfr portloua of the 
body. The oral, like the abdoniinal suokpr. ha^i a eentral imditioH, Tliii idiiehi-HkH 
promiaent btirder of the heiid ia pierced by nunicroua (flaiid-poreo. The head IB 
naked. Doth loljed testiolc-M lie uluHvly lH:hiud tlic abdominal mucker, before the ovary 
oud the vttuQ^Iy developed uteniR. whiNu' c-oilH^ihitie through clearly. The anterior 
c«il» vrbieh uouLain the nmture ora are black, the rpmainditr rmityred. The penis is 
loDg'Ood filamontouH. Tbo embryo, which in almort complett^Iy devoloiwd in the 
interior of the ntenin, in oval or spherical, ciliated anteriorly, and proridod with » 
apikelct on the veit-f-x of tbo head. 

ItM aUxle, like that of dut. fu-jvilifon , with which it is often mmociated, i^ in tho 
liQ«-ducu, ettpcciuUy the small outii, HumoLimfK tdiio in tho gall-bltidderarwl intcdtlnes 
ot i&eep and cattle ; iteldom in deer, mhbitri, harcx, Kwine, and exti'uinely seldom in 



nitiTOMt'M OPnTBAl.MonilM. (diesiso.) Odoo found in the oryKtalline lena. 
niHTOMvu iiFrriimn'UYKH, f8i»:wji,i>.> Twice fonnd by Hii.hak?., iu %ypt, in 
very iar^^o nambt:ra iu the ttmall inteHtinos. 

c. With wpamtfl Mjxiial apparatnsps. Bodies lonp and nhmdi-r ; in the female almost 
cylindrical ; in the male, the bock part of the body flattened and ln\olnled. 

DiflTOMfM n.KMATOuiru, (mi.nARZ.) 

Oral and abdominal micken of equal size, near to one another, on the anterior part 
of the iHwIy. The genital pure close behind the alKloniinal wickfr. Color, milk- 
wbit-e. Tbf mole is shorter 1 12-14 mm.) and thicker than the feninh>, and han lar^'er 
■Qcken. The anterior j>art of the body which bt-ani the suckers indistinctly Hfttt«ned, 
while the poetcriur, which quite nuddi'tily tliickeuH, ujipcara cylit^dricAl, but upon 
dnoor fcxaitiinnciou iM found to l>e HaLtcut^l. The apparent cylindrical form ariiica 
from a fnnow-like incurvation of the abdominal imrf ace. The folded Ixwly i)o»u.-riorly 
forms an incompletely clowxl tnl>e for the recc]ition of the fcnir.le. Tb«: niidrj^-nilal 
ocjgaus consist of tbirkly crowded seminal vehicles, provided with a ningh^ duct. The 
•orfaoe of the body is covered with liltic spikelete. The ffmale has a long (14-19 
nm.) and ((lender, alniDMtcyltiidricnl body. The iniG«tinul L^nal dividt^ for only o 
short difdance, and then its diverviooM to^'uthi.T enter a single blind pnneh. near to 
which the ovaries extend. Th« elongated oval ovary forms at the i>0Bteriur extremity 
a canal, which, joined with the onrhict, ext*«ndH tt> the genital pore. Tlie embryo in 
cylindrical, and terminates anteriorly in a pointed pro)j«^M3i!< ; itii Mirf»f« ia covered 
wirJi thick eiJio- Any farther ui(:tAmori>hosi» ia unfciown. 

Tlie ''**r- A/wn. ia very fre<iuent in Effvpt : In the vena portie and itn branches, tbo 
aplenic veins, the mPMcnteric veinn, a« whII rm in the texUirus nf the luteittinal ormui 
and bladder. Its ftiiMl i» the blu<Hl, thi^ corpuMclcti of which art! alwtiyf> found iu its 
btestine. In the tosscIb it cau&es voriotu anatoinioal obstmctiona; in the mucona 



122 



KEUATODCS. 



memltniDe of the bladder. tiralerH. and of the iubestinnl c&iial, 1)T|i«nnmiiL, baeninr- 
zfaofre. pig-mentation. Dodulea, pastules. and uloera rsiienibllDS lIkxh) uf dyneiiiery m 
cond^lonrntouM excTC»oL>uc(.'« ; aometimtta obntmotioD of tbu ureurs witb couseciitiiTe 
fonnatiou of ualculi. p^vlicis, (uid hydroufphrojua. Aooonlijig to GutKHiNOKH (-■IreA. 
tL Heiik, IMiU, li> 4tiK cxotio basinaturiA, at least lit the Cftpe of Oood Hope, is due io 
di*t. haul. 



UOKOSTOUCU. <ZBDER.) 

Diffem from I)iiitimii3-m chi<>(ly in the ab«encc of tlm abdominal endear. The oral 
saokor aI«o has only n xli^Oit independence ; thu pb&r>iix, luuaUjr vexy well derelopvd. 
The f«nita) pores nre noar the anterior extremity. 

MONonoML'U LEMis, (NuHUHASN.) Ouce found In the cryAtalUne leii&, 



2. Class: Neuatglkia, RooNti-woRsis. 

Wornia with roiimlr-d, poiichud, or filnmontoun botiira, wirliniit rings or 
■egmenta, Bometuuea n'ith pA|tiliM] or hooks on the auterior pole. The sexca 
are distinct. 

First Orper: AcAXTnocEpHALi. 

FouchcJ round woflub with riiitmed vortex bearing hooks, witlioat moutb 
and intestinal canal. 

The chief Hpecies. BciiiNOiiHiiVNCirrd, inhabits the iuteAtinal oanal of aeveiml of 
the vei-t«bmt^fl. Oni; of thin farm, not yet wixiially luatnre, iraa found by Lambl in 
thu small inteatineii of a leocsBmic child. 

SeCOXD OaOBR: KEMATnnES, TltRBAD-WORHS. 

iiound worms with lengthened, thread-like bodies, with month aud 
intc»Linnl c;inul. 

The armafiiciit, when present, consists of iiajiillffl in the neighhorhrtwl of 
the month, or of sjiikelets aud hooks within the oral cavity, llio niuuih, 
on the untei'iur oxtrntitity of the brHly, (iiieu-t into a narrow u>RO|ihHgM8f 
wliinh, for the tiiOHt part, ililates ititti a niiisciilar phurynx. Then follows 
an intestinal tube with ct^Unlar walls, which terminates on the abflomittal 
surfiict". not far from the posterior extremity of the body, in the anus. 
The bard skin, often trs?isvei-si.'ly wrinkled and eonsititing of aiany layers, 
inclosi-H the Htrongly-develo[H;d innsenhir layt-r, Tliere am two latenil 
longitudiinil striae of free niOHcles, the so-called Hide-liue8, i. e., organa of 
excretion analogous to the watfr-vcFsel-systt-ni, which together opc-n, by 
means of the truuttverse vB>irtel-[>ore, so-called, at the np|jer [>art of the 
pharynx un the ahduniLnal snrftu.'^. A nervous a^steui i]\ fomi of a ring 
around the oesophagus, is iu many certainly demonstrated. They are 
sexually distinct. The male ditfers from the female in its smaller aire, and 
geuHt-ally by the curled })iiKt<-rior extremity uf itji hiiily. Thu male and 
female genitals nro extended, forming single or coupled pouches, whioh, in 
the upper portions, represent te^ticles and ovaries, in tlm lower portiona 
ducts and reservoint for tlie procreation nuitcriol. These coupled ovarian 
|Knictiu8 are placed upon a short vagina common to both, which opens 
tlii'ou^h the leumle getdtid poiv In the nitdille of tJie hiHiy, or iteitr the 
anterior or posterior |>ole. The male genital pore is aituaced at the |H«Rt«- 
rior end of the b*j<ly» and pi,isswsKe8 an 'uvrnn for copulation prot*xit<?<l by 
prominent 8]iic\ihu. The nematodi'4iaiT]>io'Uy uvipaixiua, jtartly vi^iparou^. 
'J'he free development of the young forms takes place mostly by single lueto- 
uioqihoais; it ia nevortbele^s often ooniplicatcd, so tliat it docs not always 
oocur iu tlju habitat of the mother animal. Many yuuug tonus huvn lui 



rf 



1 

■ 

I 

I 



4 
i 

I 



^ 



NE1IAT0DE». 



128 



•bndo alto^lhcr diffrrmt from that uf their parent-s, and often the yoiing 
ftuU sextiull.v iiMttuiv nematodes inhublt (JitiVreut or^uns of the sauiouuinuil, 
or eveu diiferent nuiniiils. The trniispurlaliini of the frvt* and parnttitic 
dwclopmt-iit fiiriii)* diHtiibittt-d to dilfcriMit orj^aiis of diffl-ix-nt Hiiiiiml», is 
{mrtlv by nifaiiH of tlii>ir own wundfrin^, )mrtly in a. pa-vsivp inaiinor by 
tneanH of the food and diinJc Soiul* uvLiiulud'*>f livt> [Mi'HMitiodl^ in partK uf 

I, Sl'B-ORDEK : 8TR0N0Vt01D.e, K£UATOI>KS WITU ASUS. 
1. FAIL : ASt'ARIbES. 

Mouth provided with thr«o li|is or |wpillm, sometimefi with horny borrlera 
aoid t«uth in the Uiroat. 0[M*niii},' for ihit jiuniH nfar the poHttirJor I'lid with 
a )ioint fjoing nut from the pointed tail, yiost of tho funus of aitcariM hiy 
b«rd^hellod eggs, vliicb develop into an embryo only aft«r h long abode in 
uioibt lut'diu. 



ASC^AHtS LCTMBHICOinES, ROtrKn-WOttll. 

Botly c}-liudncal, poinlM at bath end«, whitish or r«ddi«h in color. Tho 
lengtli uf the malv renehea 2Mi nini. ; thiclcticHM, 3 luiu. ; the lenjirth uf tlitt 
female, 4U0 mm. ; thicknetu, ^.!t muu The skin i& tnuisvcrsely marked, 
"with fonr whitish lou^itudiuul htiiiu. llic head, oouaistin^ of ilwec semi- 
luiuir li[>-&liupi*d parltt, in sejHtt-uted fiuin the budy by a groove. The tail 
}f thi* male is conical and hooked, that of the female, blunt. Tlie maid 
_enitat.i are .<otiiat<.'d antortor to the tail; thusi: of the female, anterior to 
Ihe i(ii<1ille of the body. The inU*stiituL ciuiul runs through tlie whole body 
and opens neur the tail. Tho remaining aivitieH of tlui budy aiv oueujiiud, 
in the f<-iiiale, by the white tilnuient«>us gcnitjits (with about tiO mm. ova), 
which, in injury to the animal, am presst^il out ; in thn male, by the toRticrlc 
nd scounal duct. It occurs very often, e^ipociully in children from three 
ten years of age, and e£p«ciQlly in autuuui. ItN cliief habitat ia the 
Jl intttstinett, wlieni-i! it ntuy wander inUi every {Hirt of tho intestiual 
from the month to the anuu, seldont into the gull, and paucreatic 
ducts, and upper re»piraU>ry tubes. In the bmall iiiteatine and other [tarts, 
the rotind worm may occur singly or in Humll numbers; but iu the KUinll 
iQt««tiut:< tliey may exiKt In vt-ry large unmWi-H (one to two hundi>'d and 
more). They wander sjHintatieuuijly in health or during some disoaMes 
(typhoid fever, cholera, «tc.), to the exterior of the body. The harm which 
theMf Monus may cause, consbts in catarrh of tlw organa of dige»li(ui, Kotiie- 
tinii'S in uiTvuuH pheDumeim (]>ulenesH of the (acv, iljlatntioli of the piipil», 
etc., and ccinvulsioua of various kinds), and in stenosis of the narrow pn!i«nges, 
causing icterus, suffi^catiou, oto. Tluiy aeldum cause perforations of tho 
intOAtinal walls and the so-called worm-ubseesses uf the iibdomiiiHl wall, 
eeiwciully in the luubilieal and inguinal regions, which contain pus, tme or 
more ruuml woniu luiil usually fo<nl or exci-ement, and are evacuated for 
the must ]>art exteriorly, Eteldom with the uriuo. Still more I'arely do ihuy 
give ri»e la acute general peritouitiH. 

A^Anrft :HT4TAX, (UDBR) AST. ALATA, (DELLTNOHAU.) 

Smaller aa4 thioaar than the pr«o<>dini;. qnite roifularly S3rmmetrical. Tbo 
feraaJe. to ISO mm. in leng^Ji ; the muLe. in 10 mm. MfntioiU witJi the couimon 
TOtrnd worm of catn. Obcerved only a f«w times. i<<equolie Utile kuowu. 

OXrtrKlt* vr.RMICULARIS, TIIBEAD-WOKM. 

Body filoraonbous, white. On the bead are three lipa and atrong cull- 



4 



RTEOTGTTXB. 

culsr ftwelliiig. The feimiles exist in much larger miinber tlinn llie tnftl«8. 
The length of the iiiiile in 4 iiini. ; Ihiit of the femnle, 10 mrn. Skiii fttruil«H, 
with ti>oth-Ukc proininencps. The tuil of the male blunt nncl curled, vxOi a 
sticker on the ]Kiint; that of the femiile, ocoujiyiug a fifth of tlie length of 
thtt body, i>oint4xl and Btraight. I'he strHight intestinal canal runs t1irt>Uj;h 
the uiiddlu of tlie body. The male genital jiore is uoar the tail ; that of the 
femul<?y iu the anterior half of the body. They occur very often in chil- 
dren, not infrequently in adults, in greater or less number, and continue 
RometiiiieH only a shurt time, sometimes years. They itdiabit preferably, the 
rectum or the whole large inieiirLtie, seldom the lower |>Art of the suiall 
intetttiiic. HometintcH tlniy iire found around the aiiuM und iu thct vnf^iua. 

Worms excit4> catiirrh in the intestine and itching iiround the unu£, 
eiqM»f;i»lly at evening, when they panly leave the rectum und go even into 
the vagina. Iti conaei|Uence of the itching artt*e nervous exoitumeota, ex- 
coriatioiuf, nezcma, etc., and^ in Uie vagina, calarrh. 



2. FA3I.: BTRoNUVLOm^ 

Mouth for the nioxl |>art armed with a horny aurface or books. 
enibraoed by a bell-aliapud vecdcle. 



P«tu« 



STKOSOYLl'S (EirSTRONOYLUS) OIUAB. 

Very hnifi, cylindiieal, red worm. Viviparous. The male hardly .5 3kf. 
long, 12 tniii. thick:; Uie femato from lOO mm. to more than I M. lung, 
8— 12 mm. thick. Tlie body blunt posteriorly; ant«riorly, f«ctint*_'d. The* 
mouth naiTow, sun-ounded with six pajiillm. The female genital pore far 
forwanl. It is distinguishiHt fitnii all the other mali5 iieiuH(oil*'8 by its 
length, but chietly by itK blooil-red color, but is easily uiisUikeu for the 
fibrin uf bload-clot». Smaller sjieciuicns can also he confusei) with aac 
lumbricoidett. It w rare. It occmii in the |>elvis of the human kidney, 
which it obtttmctji, as well stH in the pai-ts sun-oundiug the kidney. t>ut of 
the former locality the worm can be cxitelkHl with the mine; out of Ihe 
latter, it may ivnch tJie exterior by causing the formation of abscesues. In 
the kidneyK, abdominal cavLty and heart of the dog, and of boasts of prey. 

8TRONOTI.U6 i^i^oicvAoraATCfi, (niEaiso,) 

nndj fllaiDRntinia, ntmi^t, dirty white, Inngficu finally ntriabeil. Tha male t3- 
14 mm luiif;, i luiii. tbiek : the foinale. Uj %'i mm. lutig. I mm. Ihic-k. Qooe found 
is the pareucbyiatt of the longs of a boy. 

Another variety of ttroogjrlua, frmoNorLUs armatvs, is the oaoae of oue of lh« 
must freqncnt and most daDgeroiis duuusea of the hon»c, tbo so-callerl oolic. — aocu- 
risui {leurm aiieur}/ma) of thr jirU;rit;a VLU\i\y\yi\\g the iutcwtim^s. Th« aneurism is 
trae and mixed, of Iho sixo of a pwa to that of u mau'fi h4>.ail, and t« d^imud'^nt ou a 
tranmatin art^ntin canaed by the worm mentioned ; through mnnminalion the lumen 
of the roHflelsifl alio narrowed, aod there ie formed For the mot^t piirt a fixed thrnmlm«, 
while the mujtcular coat bypertrupblua and Lbe adventiua !» iudumted and thickcuiNL 
The thrombua. as iiuch, oad tralioli from it. give riiw tu iluii(tcn>u8 s\mptom» : bttm- 
orrhngio iiifarptinnR, [innilywifi i>f the muftenlar cnat of XMf- intpxtinej with i^oni^tipo- 
tinn and Htmnif rrn'tpntism. ru]itnrr of the intestiue ; by the pnigTt'MJi (»f Ih* di-easu 
back along thi> meaenterio ortcricM into the aorta, diacaaos, espocuiUy pamlysis ot tbo 
hind oxtrcmitica. Conaolt BoLUNaKH, OeUr. zttr vergL Path. u. a. w. d»r Hau*- 
UiitfTt. lS70u. 1873. 



A»CHYL08T0«trM DfOPRNALE, 8, 8TR0NOYLUS PCODBNALia, 

Body cylindrical. The head turned round to the surface of the hack, 
with a wide mouth and horny mouth -capsules ; on the upper border two 
strong cluw. shaped hooks. Bursa three-lobed. The uialoK roach 10 mm. in 



TEtCnrSA &PIBA1J5. 



1S5 



D^md I mm. lu thU-ktiefts ; ihu fttinalA, 18 mm. in lungtli, 1 luiii. iu 
til ick 114 ■;£:«. FouuJ iu the dtiDdciiuiii iiud bej^imiing of the JLJuiium. la 
ItiLly, hut i'itp4^ciaLlv' iu Hgi,'[it atiil in Irupicitl cmiutiies; souietimea Hiugly, 
ftoiiiL'timt's ill verv gttuil iivtiiib«frK. It hileH its way itito the iiitu'otiK iimnt- 
limni:-, pierci'S the suhtiiucuiis ccllulnr tiH.sue, aiid subAists oti (he lihxxl. 
AfiiT iifi romdval Hu'iv vi-miiiiiR lui tTchyiiiosiH of the size of a lentil, the 
cuntit* uf which pixtioiit^ u white spot of the size of a iiin'H ht-ad, with a tine 
Jiole. 1-hit of these wounds the blooil ooitt's into the iiiWstiiial iniviiy, 
Wht'd th« woim is in the suhmncoiiii ccllulHr tissue, tlte inner sui-fuce of tlic 
iulefliiue {>reM>nts Qui elevations of the size of a lentil and of a brownish 
color. Seldom ttingie, montly by thouruiudti. It gives riiH) to auiemiiij aiid 
the very extended Kg)-f)tiiiu chloroKis. 

The Sfrt^ng. thiwt. probnblj pBMeit ita youth in dirty water, and is thence oonrvycd 
irith th«> firink ttnmdiatolj into the iutoxtluul caoal. where io a few weeks it uaaumes 
it ■ r..nn. 

J to GlllRii'lNOlEH iArcA. d. IlaTk.^ 1R(16, p. KH1>. tropical chlorosis 
(^c ■y.-.y,., . id moat probably depeudeat upon iho a He^iflMiomutn. 



3. TAM.: TRIOHOTllACHEUIi.K, 

Modw-atcly large, longitudinally striated worms. The body is for the 
most part jirovided with a thin, elougnted, neck-Hke anterior Begment. The 
ttiDUth, small, without pupilhe. The peiiiu with a tubular aheuLh. 

TSK-llOCEPMALtJa DISFAH, LONG TUREAD-WORM. 

Btniy ahon, abuut 2 cent long, 1 mm. think, to which in attached a 
filifuriii imck, 2<i-2.'> mm. long, Bud head ; iu the mule, spiral ; in tlti' feiiial*', 
sCnught. The tail is blunt iu the male, pointed in the female. The uiule 
is lighter eolored than the female, the latter being darker from thepresenee 
of u\a shining through. It is fuuncl iu childnm uad adults. Often in the 
ucL-um oud aaeeudiiig eotou; leHA often in the lower Bmall inteatine. Ofteu 
fonnd in great miuibera. It:« elfects are unknown. 

TftfCBtMA BPIBALI8, (oWEN.) 

Occurs in man in the developed and uiuIevelo|ied atates. 

The mature trieliin:i in attt-nualed at the antc:rior extremity; at the tniJ, 
blunt, ixtundcd. Tlie inteHtinal canul jMisses direct through the length of 
the wholo body, and is divisible into trsophaguH, aLomach, and rectum, 
Vivi]iarou6. The male, 1.5 mm. long ; Uic female, 2-3 mm. Tlie female 
geiiitMls lie for the moHt part in two-thirdH of tiiR iKidy. Tiie testicles are 
located in the last thii-d of the body. Found in the small ink-atine, leea 
often in the large intestine, of mau, swine, of the dog, cat, rabbit, guinea- 
pig, ntt, HUfl of isfihited birda. 

In tite immiiture state the l>ody jr filifonii, about 1 Dim. long, atui has, 
bc»iih-« ilir inU'stina! canal, no internal organ-i, ur, at the most, only rudi- 
mentK of jturh. The triehime. twict^ or three times 8|tinilly coiled, oi-cupy 
the volirnt.-iry, Htnated muKculur fi1ir«*H of niun and aniuinlti, witiiiu very 
stnnll, elliptiod or l«mDD-shu|>i-d, thick-waJled capsules, which later Ivecome 
euK'ttii-'UMs, and ilioloHe, for the most part, one, randy two, very rarely tliive 
vrorma. In this state they remain for years capabie of develoj uncut. 

Prom au obfierTation liy Ki^Tscir (trichiiiosM iu 1U4S, iu ISttfj second ampaUition 
of A recurrii^ mammary caoour;, tricbinaj ucuui^'ini; tbu muficles maj attain the age 
of twffntj-fottT rem t Virefi. ArcA., XXXVI. p. W9). 



Ou the HOPond tlnv after thr iisr of raw flf»fih rnntninin^ tiichiim'. and tlie 
coitsef|iu-iit fiitrnnct' of Iricliiiia* into tlio tiitostinnl cuiiiil, nnil ufier the 
ilig(.*Ktioii of thf^ iiiclcmn^ rapf^iile, the woitu reuches ita full stxiiul matiuity. 
They thpre co]mhite, luui on the sixth tiny rliereaftt-i- ihfi fi-mnlej* biing forth, 
in fpvnt nuuibPTB (ubotit I,OUO), living filanientotta ("iiibpyos. The young 1 
iluuiwlitttt'ly {on the tenth diiy iifter tlie use of the tnchina-Hesli) btrgiii tbtdr ( 
waiidei-iiig, pierce the walls of the iiitmtiue, Rud, piirtly through the ulMlum- 
iual cavity by way of thu iriteriii<i»culnr connective tixKiie, (mrtly ve'itU tim | 
bh^oil, thoy ri;aoIi tho vuhniTfuy unisclns of their bean_T. The nxiscU-s 6n«t | 
nftWteii are tho9« of tiie body and head, then those of the extr*'niitit'«. Tlit^y 
pieree into the interior of th^i muiiclt^huniiUtt aiid already on the foOi'tOPiilli i 
day rm»ch tW-. hizc and nrganizHliini of living irichinn?, undevRloju-d, in tWJ 
mir-iclcs. Thn iiif»;ct*:d njiisclc-bwudle veiy soon loses its earlier sti'iictuir 
while the fibiilire become homogeneous or assnme the ajipearanc*? of a finely 
grantilai- siibHtiinuu ; Inter the Hai-uulennna tliiekeiiM and iK'giu8 from the enJ i 
Uy uhrivel, wliile the jmrat^ite coiln itself within in a Hpirnl niaimt'r, nnd thel 
inhabited place is enluijjed und spindle-fthuped. Tlion, under the thickened 
Rarcjlbuuutt the formation of tlie Iemon-sha|ied or Bpherico] cyKt**, tln-ough 
hardening and CHlciticatir>n o! the horny Btibstiinci*, Ijeginn. SiniuIt«iiHoii'«lr i 
there uriscK in the neigiibt»r]iotM.l of the affected ninscle-bundle a celhdar 
growth, which originati's in the nuclei of the capillaries tjieuiaetveft and] 
their surrounding ti»«ueK, »» well at> in the nuclei of the mn^cle. Out uf) 
the former are foniied new capillaries, as well as a thick capillnry network 
ai*ound the trichina-cj»|>aulo ; out of the latter, new muscle-fibrps, no that inj 
the greater number of coses a complete rogpnei^tion of tho mitscidar tissue i 
occurs. 

The trichina diseiise asftnnies varioits forms, eJt]»ecmIly according to theJ 
nninl>er of ti'iohiiiH- taken cu^uible of developtni^nt. In the Kcvrror cases I 
there occur in tlie tii-st week after the infection, digestive tronhlen of ditTer- ] 
cnt degrees. In the second week there srise the cjnito chirncteriHtic nronp I 
of syniploniH in tho nui.sclcj* of the trunk nntl extreniiticH (If-ding of! 
atitrncw*, Iiariiliea.-j, i«tin from pn-SHure and nioveni*Mit, hoursene^s, lUspnira), 
fover, coutiiiuatjon of catarrh of tlie mucous raeinbraiio of the slomueli,] 
tedemn^ etc. It ends in i^ecovery» sometimes after a long time, or death. 
Light cases present no symptoms, or such as are uuebaruclcristic 

Zrwker with Gl-:RT,ACn rtg'nrdi* tli«hog-asthe tm« snrt ori^tial buiirer of irichmie, 
the tnio sonree ot tnol)iniT>. Infection of hogn tai:es pinco by swallowicg^ intfjitiiiat 
triohlnte snd emhnrofl which had h^tm pa-wM with tho excrement of olhrr hr^, Iril 
eepecfslly by eatinjr iricbiuous Ilohli of othur hops ; sIro by feedinir the n-Iiise llt-sb a% I 
butclit^Ttes to th« liugv Id the yard. Trichiuous ral^ are a ugn of the prewntwofJ 
trirhiitDDH luiy«. I 

Vim now. Arrh.. XVIII. p. 330 Zr-'.NHER. //».. XVTTT. p. Wl ; J'lhi-rtt'rr.iier] 
Gff. f. iVntur u. /Iti'Jt. z'l Ih-rvUn. IStll. n. fle. p. \\» w. W : A .-IrcA. /- KUu. J/rtf., I 
1871, VIII. p. ;(H7. Bhulkh, Dif Tri^iitfnkr.. 1«IW. Lkitk.mit. I'Mrrs. w*. Trie\, 
lipir., 1800. FlEULKR, Ardi, d. J/eiUt., V. ji. 1. CoLsaRo, DeutKhf jKUn., 1(<<IH, J 
Ka 10. 

4. FAM. : FiT-VRin.f:. 

With very long, filamentotis body, sometimes with, sometimea witboni 

pflpillw. 



FII.ARIA MEDlSKSSia, THHEAP-WORM, fiDrKEA-WORH. 

Femsle, 3 L'ent. to t Rl. long, 2 mm. thick, while, becoming thinnec 
posteriorly j the male, much sm si Lor and little known. Inhabits e«i>e«La)l^| 



FILABIA. — ARTHRnrODA. 



12T 



the snhcntarieoiiR cellular tissue of the foot, lean oflrn other iilncoa (scrotum), 
and lliF> ciiiijiiiiciivH IniHii. Kuuiiil cjiity in tin|iicAl cniiiitric8. I.Ipb in t)ip 
pliict;» tni!UtiotuMl,H<>iiifiiin«>3 coiled, soiUfUiueti Htivtclifd otit. Exftmplcs of 
il are fouuii nuisl uftejt Hiiiglj-, fiomrlimett in great niiuiburn. Whon the 
brofKl of tlt<* fr^ttiiili! wurm Unn rviiohed iiialiiri(.y, theru uriaes in the ttkin u 
sort of awclliug which in )K.<rfi>raUt4 ; with various local aud geucral »)'ai]i- 
tuniK. 

Tbc rewuchn of FrdT0CTTKNKO la Turkcetan mnko tbn order of life of the yonaf 
lilaciK w followB : The fllaria> alrc-nd^' iii tlio wumb creep oat. arc enme tinio tnt 
in wat*-r, then wnnder into the HiiLnll fnwb-wnter cratw ifffd^)^ and If tlioM, willl 
dirty itnuKiiii^ w;4t«-r, iire I'finsnmni Uy man, ha liocomeii infcotad. 

DK.tci'Ki in.rH (ii'Ui'i. I'ntler tbe conjnDctim of .^ihiitpiana 

P1L.VHIA LKNTtK. lu tbo <ir7iiuiUiiie Iqus aod liiiiinr .Mur^a^uL 

PILAAU IIOMJMA s. UKt).%<:iiiALi». lu the bnmcbiol glandii. 

Claob: AkxeliovK, kixoed wokms. 

Cyliudricu) or tlntteoed worui)>. mMMty with scfrin^ntod body with brain, oeMpIttgMl 
ling, chain of abdontinal ganglia, aud bloodTCBscla. 

Ordkh : HtKrDiNia, lbbor. 

Body with ttUTow rings, vrlth t«nnlnal central disk, iritboab feet, hemuiphrodite, 
and inuetly paraubLu. 

srn-oRi)RK: oNAxnoiiDKtLvB, eri.i.-LEEcn. 

Throat- provided with three, often deotated gilln. lonsitndinally plaitt^ ; 4 to S rinffi, 
for the roost part, are npon one KCp^ncnt. In front of ttiu month if a )irt>minent, 
cuzlcd. ff|)uan-sha)>ed disk, which funns u Hort uf urol tiuakbr. Iim UIikhI i^ musUy 
col(>red red, 

IintUbO, BLOOD- LKRCa. 

ITaa nsnally nmctyHre dUtinot rin^ The anterior rini^ bear ten spotfi (eyes). 
The uxmIv j^cnital {tore: lt<^ lietwmtn Uie iWAnty-fourth and ttrnnty-fiftli ringH ; Litat of 
lh« ftMiiaJf, lit^twHt'n tbf twunty-iiiiithand thirtieth rititj*. GiUjtdcatiite, IlieiiUiui- 
acb, uiih ♦'Icveii iwiin^ of laU^rnl jMinches. 

niHriHf MKt'H'iNAi.iK, With its distinct officinal varieties, has eig'hty to ninety 
fino t«i:th CO the free border of the tjilli. Is otdtivated in leocfa-ponda, and needa 
tlirco yean to arrive al ncxual maturity. 

in. ABTmioroDA. 

Trfitei-ftlly ajTiiniPtrical animals with segmented hodiea and AvdcitlAte ap- 
pendtigeH (linilm), with bi-aiii aud abdominiil ganglia, rropn^^nttun prt'ixni* 
<leiat«lv Htrxutil. 



Class: Akalhsid*. 

Air-hreatbing arthropods with head und thorax blended, without feelers, 
vith two [iniin of JAWH and IcgH, hiuI ittidoinr<n witliaut luetnboi'a. Sexes 
distinct. Mostly ovijmruUD, sulduiu viviparous. 

OkDER: LlSOrATULll>,K, PESTASTOMir^ 

Budv wiinn-slmfK'd, elnngatod, Hut or rounded, ringetl. T^fontli nn tho 
iiut«*ric)r piid. rounded, open, BtUTounded by u horny border. Four li^, 
houk-liki', Hud nhcuthed. Surface of the body bard and pierced byHtigmata. 
The feitmie gciiitnl opening in the t^il ; that of the male on the nbdoniinal 
surface. IVnin duubJHcl, very lung, tiliform. The nude snialler than elie 
feiaale. MutainuridiOsiH complete. 



128 



ABTIIROPODA. 



PEXTASTOMCM T.tSIOIDES, 

Fcnialo HO, iiiaIo 20 mm. long. Xiihnbita tlic nasal cavitiefi aiiJ frontal 
KioutHw of tb« dog Will wi»ir, very lU'Iduui iboae cif tbe hoi'so uiid guat. The 
eiubryos wiiliiu Oie sitf^iU of the ovii, ure expt^lled with the mucus and ad- 
here tu pluiiLs, and tlxMiRe ai'u Utkcii iutt} llu^ fttotiiH.c)i of rabbitJit, harf«, goat*, 
luau. In uiiui, oti wt-ll ua In all tlic luMt-iiiLmod auiiiiuls, only tbe lurvft are 
fuuud. 

PEXTASTOMPSt DEXTICCLATTM, 

Thi« fortii is 4-)J mm. long, 1.5 mm. broad, always oncapfluleil, ctirv 

to the Hhupe of u hatf^iiioon, catcilierl. It ih often found lociitefl on the Rur- 
fiico of the liver, B(ddom in it« inlei-ior, esjtecially of tht> left lol>e, on th« 
Hurfat-T of ibit tiiiitill iiitf.stinisM, atomui'lij kidnrytt, apluuu^ lung«. Fiv>juenU 
It is without coiwequencca. 

Twice have I found a Uvioe, wcll-fonne-l. but not fully grown, prut. <hnt. in a 
d»tiuctl.v iirominent recess oC tlio surfauc; of Ihe Uvur. which reccsH wan of the aixe 
of ft half-pea, c<rtit4ike. but nottunootb, and not providM with no eucloidog inem- 
branp- At n didtanut* from Uibm! wen* found three ealtnfiuil jwntiuttoma. Also I found 
two ppfKiitnuoM (d well-formed peiit. ilt-nt. on the mirfnce of the \\\ng of a mangy oat ; 
cue wua couiplctoly caloified, the other in the ])ro<.*CM of colcitic-tion. 

Order: Acabin.«, mites. 

Body compact, inarticiilnt^^ ; ahdomrn blended with the antprior part of 
tlie body; apparatus of niuuth fur biting, Kucking, or Atiuging ; respiration 
by meaiiB of troohcie. 

FAM. : T>EBMATOt'ntU, IIAm-FTJLLIITT.E MITE. 

Elongated little mitt'A, with lengthened, wonn-ahaped, fringwl alKlooieo, 
with snokoi-B and atUetto- shaped jaws, and four pairs of short, bijw-rllta 
atam);ed feet. 

ACARUS FOLtlcrLORl'M, COMKDOXE-MITK, {siMOS.) {MiiCTOffiMUir pJ<ltl//»UI, 
DertitodfX Jvfiif^ulornni.) 

A slender animal, about 0.2 ram. long. Organ!* of generation and dt,*- 
▼elopTUHnt unknown. Very common. Found in most men in the ear- 
wax and in the sebatteonR glands of the external organs of hearing and of 
the feoe, seldom in those of the chin, breast, etc., not In those of the extrem- 
itii'8. In mo»t cases, many animals, stimetirnes even teulo twenty, aw found 
in one follicle- With the exception of occa»ional comedonaa and acne-puA- 
tuleSf ther« are no consequcnctti. 

Mitea similar to the nMnafoBie. occur also in doga, cata, ihcep, bats, eta 

YkU. : ACAIIIXl.fi, UITKS. 

Bodies micro-^iv^i'ic, compact, soft-skinni'd, with homy stalks for thesiij^ 
port of the limbs. Legs mostly short, stumped, and pi-ovided with disks 
for prehension. 

ACAHfS, geu SABI'OPTKa SrABIF.!, ITCITMITE. 

The female i-talwiut 0.r»mm. long, 0.4 mm. broad, dull grayish-whitc; the 
male almost half as large and strong. Body roundc<1, ai-cht-d, with shallow 
indentations nud txvellingH, an<l fine parallel transverao striiv. f'ln the dorsal 
iiurfaoe ui-u numerous conical elevations and spines; on the back, sides, and 



I 
I 



ACARUS BCABIEr, KTa 



139 



klatcd long biist lea. Heitd rutiiiiJ, wiili LrUtles aiul maiuiiblcts. ]ii 
itmt* Hlute theif! luv eight Icgn, of wliich two are xilimtcd anU'riorly 
mnir tli^ lieiitl, uiiU arc provitled with tcniiiiml diskK ; two iialifi are faitiiHtt-d 
|K»iUfiiurly, iiihI t<rriiiitiiiU! in h>ng htroiig biit^tl'-s. The ova arc oval^ about 
0.2 iiiin, long, and la tht^ni tL<< young laiUi* aru Hatnt'timeft seen, which afier 
cn*i*|»uig forth hiivu only om> pair of fui-t imhtoriorly. 

Tilt? fi.-Diiilu itoh-niitu penetrates the c]tiderniia of the inner side of tho 
fiugi-rs »uJ of the wrist, nud forma under it a somewhat winding ]m.s8uge, 
which is coloi-ed hi-owninh by dirt nnd thtt excrement of th« mites. At the 
eu^l of the caual (ouaiciUim) it (^rforates the corinnt, tJiei-ein giving olf au 
•crid tit|nid whinh cxcit«« itching, and, cunKeiiueiitly, the Mkin alfection in 
known a» the common iteb, lu eases uf long duration v«iieeiully, theru are 
Dot rari-dy found ubuudaal M-ales and erubta, the ao-cuiled itoh-scubs. 

Acvordtn^ to Delakond and BotTROUiUKOs, the mraapte* homu%U ocoturs also oq 
the dog', the hon>e, out] Uouh. 

(PCKsTaXDERG. Dit KrdtsmSArn dtr MentfJtfn unit 77tifnt>. 1801. 

Tilts uuiea {mi ro>j>teA or dmmttndf.fUiif) acoidentally l)ome by man aro: the true 
tamyitra/f/u, Mrc eaaiA, mira. eqni, tare, bovie, mirc. orir. 

rxu. : uoD«, Ticits. 

Larger, moetly blood-aucking mites, with firm back-sUicld and iai-go, ex- 
Jended deutnted mnndtbleM. Tliey live ujioii grasHea and upon trees of the 
lieu and foreut^, and only occiLHiniially iire i\n-y found upon nuin. The 

lalr ninks itjt pioboscLi into the akin, fills it«t-lf with blood, by wliich 
it swells out and eaust'S, lH.>Kides pain, Kiippuraiion of the |Mirt utfocttn). 
There w*e: Um/es ririntts, tho common tick; «. marfftTuiituif the bordered 
tick ; ix. 'imrnrautix hmnmou. 

Tb« riraMAJtvsKirs Avinsi. or aroas REPt.Kxrs, is likewise found on man, 

ailriitnlly or when in wunt of other eubsistencc. It lives in dove-cotes, 
ben-roc>8t«, biid-cages, ete,, uj»on the alTected jiniuiidK. It gives rise to an itch- 
ing, burning puin, and leaven Ixdiind a reddened, Komewluit Mwollen bitt«n 
place, sooiftinica ulao fcdenia, ete. 

Bo*icntT,TE ( Vireh. ArtJi,, XVIIL, p. M4) aud Gi!:ni<TACKKR (lb., XIX, p. 457.) 
The AJ1GA9 fuoaicrs Ukewine aiiixauK to beluug- to ilm family. 



FAJL: TnOKDimtIA, RL'SIKINO-IIITEB. 

Body brightly mdured, covered with hair. Tlicy run upon plants and 
upon the ground. Tho young, six-legged, live panndtically upon iuseetH, 
dtc., sometimes also npon man. The 8o-call«t lbitis AtTCMNAbia, goose- 
berry or liarvH«t mite, often in givat number)*, |teiiftrate~«* I be skin ed' the 
miners, etc., in ftummer, cnnsiiig troublestnne iidiing, inllamniation, and 
ftwelling, sometimes even fever. It is ea.sily recognized on account of its 
reddish color, benoe the name of the afToctioit, Rouuet. 

<0trDOE!V. FTkA. Areh.^ LIL, p. 255.) 



Class: Hexapoda, insects. 

Air-breaihing urthropodM, whose body gwiernlly is distinctly soparato into 
head, thonu, and abdomen, with two feelers tm the bead, aud three jAurs 
of lugs on the tnpartit« thorax. 
9 



BlEaUPOCiA. 



Order : RHVsrnoTA. 

Sm-OtuiER : ArxERA. 

Small ^TiiiglcHH mitects, with sliort, tumed-in, fleshy benk, nad pierciug 
hi-ifltles, or with rudimentary luring mouth, with a body posteriorly com- 
posml, uRimlly, of uIdo ftvticulations. 

PEDirULUfi TAPITie, hrHd-louf*e. 

PKi>i( ur.rs PUBIS tW PHTiirHins ixourNALis, crabs. 

PEDiruLUs VEaTiMEKTi, clothos-lotise. 

Tn vttry mre caiu>^ t1if-re ari<t«H tJie nn-callml Imrne-dUMue, rirTiiniiAsrx, in wblcb 
tlie c1utli»it-la»Hf> is rniuid iii nlceni of the Hkiu, luit] oveii under Lbn lOiiii in liotlt 
nod puHtulcs. the ooverud !oiue-utcon, Bo-called. (Lakdou, tfVn. rattt Wacfu:n»eAr.t 
ISCS. Nufl. 17-10.) 

Sdb-Orpbb: Hruiptbra. 

ciMBX LEcTiiL.^uii'i), Aconthia rotul. Bed-bugs. 

TiRcnow {>4mA., LIV.,p. 363)(l<!«aibeaaniinineiiBelDTaidoDof wood-Uoe {eUttASbf 
tnqniUna, v. Uevden). 

Order: Diitkha. 

ItiKt'irtri with Kucking and piercing month'&ppnratua, inarticnlato thorax, 
with ciiticular Hiitt'rior wings, 8wiug-l>at8 /or wings posteriorly, and com- 
plete metttinwphosia, 

rt'LEX IRRITAK8, flca. 

pi;i.EX vet DERMAT0PH1LU8 PES'ETRANS, sand-flca. 

The Utter Utos in Sotitli America. It piercea tbo hairicas part* at the opldcrmi 
nn ()1>U(iri«: dlrc-cuon. atiil hnviti^ r«jiclif>t1 the cutin it dcpoaits numeroti.' ova, whi 
the animal rormorl> apiKjaring im a ton^ broim point. pwpUh oat into -. > — ."••! 
Toriolo, of tho eisio of a poa, WTieo the oro reach matnrity they ore • \nA 

develop further in the sand. After that the biAoct dk-ft. and is cut off '> -jti- 

dermis. The parts of tha nldn dcjirivcd of Mensibilitjr, uf those olteoLud wibb loprcwjr, 
often show nuinerouH hulen caused hy th** saud-IkMi. 

Of the Dijitern thu fuliowin);, partly pnranidc. im> worthy nf tioticw : 

CE8TKU8 iioiciN^it^ god-tly. It l&ys its ova in the idun of man, ^ving riao to 
boiU. 

mi;w:a vomitorja. tnrffe. blue-bottlo fly. 

BARi'ortiAOA, common tlesh-dy. 

MnscA noMlcaTir.v. limwe-rty. 

All depodit tbeir ovu witli the— for tho most part alroady formed — Umn, or ttie 
Utter thamitelvt-K In the cavittes of the mncons mcmbriuics nf the •nrfacs (conjoita- 
tiro. nasal oaTiticis Ta^inai. upon exooriated part«. in woundu and tilcent. lu nu« 
cuacM the Urvu; untcr l\w »tomnch, whnn; they remain !><>vi?m,l durt nlivc. and pn»n1i1y 

?:i»e ride to intonwi catarrh of that urpiu '(Mk-sthkiik, Vifrfi. ArcA., IljMW. and 
rKHnAKrrr, Jnt. Zt-v/ir.. iniil. p. 4&-iV Tuom.vs (oml com.) tiaw a sercre car- 
dialgic nttaok in couhetpiencu of a living wasp having entered the ttomaoh ; r- 
lovtry ofter the w«ap« of the wa*p by vomitiJiK'. 

Ai-'uordinif to Onjuerki. (.1/r/j. ;/vtt., ItiTiit, June), a Wj {.I'Ufilh h'tmimp&rat) 
oixnn in Cayenne, whose larvw jfivea riiw in man to very ncvcrc illnesa and ©Ten 
death. When pro-^nt in the naeul cavitiw and frontal siimwR, they came pain, 
hicmorrhaffc, meaiDgitlR, eta 




4 

1 
^ 



tt. CONTAGIONR AXD MIASMATA. 
EriDEUICS ASD ESDEMICS. 



Iit<>ratura of the imbject in fonnd in worlcs on general patholof^, on tho aoat« 
leraatn, and In Grloslujrer'ii "* Infuctioait Diaeuaea" {Virck. ilandb. d. »pm. 



Tho 
exnntlieraatn, ._ ^,. .- 

I*utA. ti. Ther. XL, 3 Abtb. 'J Ault., 18(Hj. 



OOIfTACIOWS ASD MIASMS. 



131 



The cause of a numWr of the most importjint (Usf-JWfs, conUgioim n\n\ 
iiiLtuiUuiLtk-, is »til| almost vinkuown. It ih iiiuj*t proljoibly srEiririi:, iiiiil 
ftflWlH tlie Ixniy liki? a \HnHoit, a virus. Ahliongli wn know only the cirfctx 
<rf this unknown agent, we in.'»y, npverthfleHM. siippone for i-ncli of thcsf iHk- 
fim a (letinite nmU'rial, l^'cnnse lUv (lisun-v fl[iri'aiU futliiT from imliviitunlK 
lui*vA(iy siok in u Kimiliir nianiu-i', or at ci'ttjun tinic'-s f^i* proct^RiIinj^ ''mtn cle- 
teiiitiucd lucalittes the tliscase Npi-i^uds, and lit^jiiiusi; the raaes of diKoiiM* in 
the* siunr calegoryt tJiUJi iiriidug, bchuve in an exti*(»ni'fly Hinii'ar manner. Be- 
tiidi-K, thfv hrtvf uim'h in common with rt-niH'Ct to thfir syinittomiiloiogy. 

The inlhicuw of »uch a vims niH»» tin' bixly wo rail iXf'EiTlo.v, nud 
th«i res|>ecttvc iUK'itMt!>« nwiiive the nntuo of infcitioub ih^eases. Tlti'se 
disf»/«t-!* furiii a *iKviiU (•i-oiii*. lunl do not inclndi; the afffotionK which »re 
iutltrpt-ndfj-iitiy ]u-0'luci'd within the l»t>l>v itkelk, hy outniJi? inthiencrx, hy 
iit-^iiii" 01 tnkim)H>t4itioiis of a kinil iwrtly oi* niifircly niiknnwni, althoiigh the 
iirtioii of tliow pi-oducts of tmuf^positi'-'n aro to the senses in part iinite (rinitlnr 
Vj the iiift:>ctii)g MilixtiiDcrs mentioned. 'lltitH tiibercnloMs, cnreinnHis. 
pvifniia, septiricmiii, et4\, not Hrising from an Kxterior rauMtt, .ii-« nut mtikiHl 
amiHi;5 llie infectious diaca.se'*. 

In the spending i»f tlit'MT <I)ftea»oa by infection, the locality of otigin of 
th«* vims varies. When tlio ^iriis, by which an individtinl beeoniet* sick, 
has its origin only within another individual aln-ady nick, fnun wliont it iH 
excn,'t<Hl in an ot'tivo stnt«* wilh the |m)wit to xpread fnnu uidividtial to in- 
dividual, thtoi is tJie diHtjiHt- fjillt'd loNTAniocs, and tlio unknown wateriAl, 
CfjXTAOifU. But if tho unknown agent which furLher jn-opitgittos the saiiie 
rlnttniMH haK originated in the ground, and is <litriisetl thi^oogh iht^ air or 
water, ».• that one nwv btfCunie inft'CtiMl without ha^'i^g met another already 
Mck, or m ihrtt the sick cftiinot be the mL^aiis of the further spi-ead of tho 
dUeMiM_>, tlwu it in ctdled niasx. 

nipw two tpxjtreH^ions for th'.^ manner of ppn-ading of individual dis*WM»« 
art' with tmati kept sliarply di»tiiict, Jati^nuiltent fever is not ooniagioUM. 
It lA wi'II known tlutt one onn, with impniiiiy, approach another sit-k with 
int<*rrk>itti-iii fcvrr; but it i» als<~« known thut a refirlenoe in certain placew 
is fhmgerouH, ^f* that the cans'* must lie in the ground or in the uir. lut<>r- 
mittent f'ver h decidt.-dly and »-8«eijtiiilly of uiiit-^iUHtic origin. On the 
oth<^r hand, in nnioile-s, NCArlet fe\cr, sniull-po:^, whmiping rough^ diphtltcria, 
epidemic |»irotttiN, na Wfll as in Kyphilis, thr> grounil and ail do nr>t tiun.s- 
jMirl thew dtseflses; he onlv bocomcH .sick witli meaides who hiis l>een near 
nnothrr airk with mcaAUs, and he only with rtyiliiltK who Una come in im- 
utHliate eontiict witJi an iiidiviilmd aflVcted with gyphiUB. Thrae diaeaseft 
arc of a decidedly contagiouA naltire. 

lu « wider ranne of diMTaiti^ff, however, as clud^rn, typhoid fever, etc., it 
is not to be decided whether they (ii*e propagiitj^l in one or the other way, 
or ill Uith ways. In th«*K» diKfMH4'K Uith wayK of prot>ag]ition haxo Wen 
observed, and on that utxount are called MiAKHAT[«:-('ONTAOiot'it. It is 1n.v 
lii'M'd liial (he ]roi>Ktu uri.siiig by the diseuMj in developed not ojd\ in tho 
Iwidy of th»' sick pei»>n itself, hut also in thi- clothes, etc., or in his room, 
in the privy, in thi- fhtor, etc., is dovelojwd or mi)lti|dieil, and only then is 
reci'ivwl hy othei's. Th'/ diHeflH<-s tlnis .trisin'^ are, tvjdioid fever, cboleni, 
y.-Hnw-fever, the plagun, hoapitiil gangrene, rlysenterv. iidluenza. pyti'mia, and 
puerp'Tol fever, [ierlmps also faiial erysipelas and cerebro •spinal meningitia. 
lint this assumption hit^ lattdy l>een eniiteKtifd. 

The acnto exanthemata (nmnll-pox. scarlet fever. mea«]ea( are exqnWieiy con* 
tai^uiiK diseoAes. Uut wbrthvr. iu a pUicc wburu a Kreat nnuibcr are tokun «ie)c, thu 
scparatiou of the be&tthy i» of f-er^'ice, it is as yet hnrdly eafe to dctermiue. but it i» 



132 



at the laa,«t improl>able. The latt«r M|M.>cinlly is in ncoordoaofl wifch tJi« »xp«riMW 
of Pasi'W in mR«sleii i Viirh. ,1/vA,, IHIT, I., p. W2\. He obserreil an c'lMdrmic at 
meaitlcv in the Fame Ltlaodit, wliiuti mtfud from Apri] to Ootober in |H40. and wlitdi 
ultocked over ti,OUO of the TTH:; InbubituiitA. Tor Hiiiy-flvi! ;ojkr» mnjuslcr* hail not 
been known on tliosij ulandx, which it exiiltuimd b^ ihts fact thai ihu i^buiil* vrero 
ulmoi^t Khut ont from the re«tt of thu world by a commeroial monopoly, and that ibr 
H>rf-nt«t!n nthabltvil inlands and thtur cnntoon hnxe very little iDterctiunc with oiir 
QDOther. r.vNi'M ber^ many liuieA (letcrmined that meoales only waa couununicatMl 
by ituuiediate inteivoarsu with tho»e luuk uf thu aauiu iliatuuc; iu a faw uikb 
iudirucily |tItr»UKh Lhu clothes). 

In Kn^laiid, since the rL-Kvarohvfl uf WilLaN and BttlOJITt eiyapelas ha* be«o 
n-yiu-ilml Hit a eontiigioiii" diM*iuw. 

ryi>hoid fnvor and cholfra are, acccrtling to the common view, ooNTAOio-uiAa 
MATic diaeaacs. They Apreftd tbroafrb thoK- ftick witb the diseaae, or by objecU 
which hav« been u^ed and hare iMicDiui! infected by them : tbcu they are ooDtagiona 
For the iirHt comsb uf cuukuvtts in a comnianity are often tbotte of pflimnu who hare 
had direct int«roour8« with the tu'^k. But vtiTy often nl«o thoy are seized who bad 
not btocHl iu Lhti Ic&jtt direct relation witli the Aiok, but who Iito upon the same ftoil 
a*i the oick, or who had dnink the wat«r infecuidby tlie soil ; thLs ia uiinsinatic pro- 
png.ttion. Tbf.a ontHide nutnn> fitmialitv tho route, of thn {mtson from the Hr«t uok 
pentun td its n«w apben; uf ticliriLy. 

Sumu. uspedally PKrTK^KuKEii. will not nccept tho idea of oootagio-miaamft^ ; 
diM-asut. Uxuiy of iliu diwa-^es iu qu««tion are by V. tnoludcil omonj; the tnui^Mft- 
ablc mioflinutic dixeaiwft. e«|K:i;ially cholera, typhoid fever, yellow f(*vi:r. ThcM- hate 
their Keat not iu ttie human Ixxly, bk £ (/. Hyphili^ and atnull-|M)X, hut in the KAUtu htcal- 
tticfl ; thoy are not a prwtiictinn uf tlio biidy. Imt of a certain locality. <:tc. : tti«ir 
pojtou in taken up from iheir lociditics like tho poison of malaria. Tb« Kproad of 
oboItstB iu Bavaria. Thtirint^a, Saxony, etc., tdiows. aooonliu^ to P., that the i-pi- 
deiilically allLClcd pUic«» of a country are not coiiuPcled hy liiu's of cdnimKtce, Iml by 
draiuagu and uh:ir»L-Uir of the hoU. NolT ban lutt-ly shown the Mime of yulhiw fev«r. 

AiMHirdinf;- Ui PkttKNKoi'KK (Z. /. Hiit., tf*73, VIII., p. 4!>3|. small-pox i« a mooh 
more ountii47io-niiniimatic diiica«o th&u cholera, eio. : lU varying froqucney can- 
not be expluinod nic;n-ly by tho eotitagtuni always [rrewnt, and the obanf;^ iu the 
individual diApoiiition of the pupuiatiou. The infectious muteriai may be profMi^ati-d 
and inur«!aitt! uIm> uutaidt! uf tJm nivaninm, in th« mitMlrata of the mrrDUndinj^ <Kilt. 
i. f.. mioM iiatiL'uliy. 1'. appi-idn for contlrtniitinn wtpeeijilly to the n-'**ur<.'hM of 
MAcruiLUso.N {(Vioitnt iu it* li<me. German hy Vei.tl.n, IWiTi, M found, that iu 
Muall-pox ill Calcutta, iu twenty-nine November uioutlut fowtMt (1-t'>2i dtiwl ; in Ibd 
March monthit niiwt (4.ii;t4). that, Ufiides. the differrDoe in tlie yearly frequency wu£ 
almoAt one hnmlrud timtiM ^ruater in 5mall-p;>x than in oholrm. 

i*t::i-TKr(KOKKK'» views with respect lo typhoid fever are npposod by BiilIIMCk t Vth. 
EhM. li. V.rhrdt, tl. AMoiHitiultf/tifius. Voi.kM. , KUti. IV/r,, IS?;!, No. .1:11. 'I'j'pbold 
fever aixording to It., is cimtn^oourt. and ih tr.infuii--<^ibli' ttinmffh tht: t*ick and tbuir 
linen Nincnrird by tbeir dejc4:tioii<>. It t& regenerated in the intestinal canal and jipruul 
through those nffeotcd, or rnuUi|>Ueii in tlie eoil, in latTinea, etc, and Rproada tbouo* 
through tho air. or drlaking- water. 

Laymen, and even many phyttlcimu, still further extend tbe couoeptioa of iufeo- 
tiou. BenJdes contajfiouM, uiiaMuiiitio and lutanmatie-contugiouK diaeiiavA. tlii^y here 
inoln<lu : 1. Slany UuKUu^ex whiuh not infrequently attrick Mivi*nil mumb«n( of a 
family, ut a motv or lem fixed periwl of th**ir livo.'*. and in whom on ioheritanoe «er- 
taiuly or probably exict^ : tnbereulosia, (wrofulosiw, cnnocr, tiout, rheumnti»m. hyu- 
ttiryi. alTcclioiLi of the mind. etc. y. Many diKeuMUi or .ipi>frarancefl of disea.'n^. wbieh 
ari»*« from a kmrj of imitation, tjhiMjcially in yhildrfln and women : gniiinyr. cunKhmg, 
|whooping-L'{)ngh ?,i, uouTuItuonM. etc. It. The so-ralliHl pAra^iUut. uuimiU and vugw 
table. 4. The zounoiios. (to-called t.°)Qdnefts, hydrophobin^gangrene of ibtr spleen. I 
and oarbunclos. nnihrnx and malijfnant pustule— glandcrH nud fucvy. m<iV<us humMum 
gt fiirriiniiUMin*), in which there in a triuiHfcrvnce between iudividaaU of dilTerenil 
BItecies. and for the rao«t (>«rt from nnimalu to num. .1. Tb© »o-ca]led purulcut-uon-j 
Uigiout diiwaw^s. if. tboae conta^one nEfectionn in which pun ia tbt; bearer of tho 
conta^^um, which adhure!i ouly to certjilu organs, and ntwavA gire« rive to only Uk 
dilHcuUii;» ^gunurrUiua. upbthalmia of the new-born. Kg)'ptiaa ophthalmia). 

Hi>i:fmir ( lI'iV/i. ir'W<r«4f)/ir., IHiU, Nr. -iH) and Khm.iu {Mtd. Cfntntl-Ztg.^^ 
\BiH. Nr. HTtadd to th« pr«wnt nninher irtil] a SKBvotrs cosT.^uiCM, which ahuuM 
explain the iprond of certain di(ien»»i»« of tho nervous it^-st^m, f^. chorea, hynei-ia, 
epiU-jtey. liiaeaBen of the mnul. According to Vi><;TRisri:u. Tornnts, etc. a mtaam 
aimilur lo that of iuturultttiut fo\-er is the cause of eudemio goitiv, which nuaam 




OOKTAOIONS AITD MIASMS. 



133 



TE9T calls hrancliin. Tt in (lisLriliutvd BotnetimeH vrith the water of a rcgioD, sanic> 
\im«-* ivitli the nir, •oinetunes writh buth. 

Tl»' isvEtTixo AOKST, tlio »|>0tciEic puisoii, is nut certainly known in niiy 
coDtii^iuna ur luiaMUintit; disfUHe. VttrionH theories hnve been brought tnr- 
wki'J oauceiTiiDg tUc nature of this poison. Of the»e the so callod ]>anisittc 
thcofv haa fuund almost itnivtinuil acoej>tAnce ; it in at [e«Ht the most j^-ub* 
abia Ititt iiivestlgiitionH ritmo<) on Toi- the Uttt ton years, ui-e, in spite of 
all the doe)arHtioti8 of observLts, not yet so far ronioveil froui duiiht^ that 
the a«3UDi)>tion of a ao-called conUiyimn animaftim cau ho regardcHl ah 
uftHiired. ForiHf*rlv, iiifei;ti<>nH diiuntspH wpth ri'ganlcd as the working of 
jmi-ely cheuiical jjafieouB prodiit-tK ; ho-Mtll^-d ffrniontaiion or rymotic disfast-s. 
Alauy |iheiKiuiriiH, f.-.sjie%.'ially cuiila^iont an- t-xplaint-d mucli niurchiiaply by 
the panuiitic tlieorj" than by a chemical tbe<jry. Therefore guseous mib- 
Klances may yet always bt^ influential us auxiliary cntisea of infeotion. 
Thun t.tf, sewnr-gasi^'s, <;<inliiiiiitiat<v.l wi'lt-waU-T, elc. 

On th« other hand, in a few eapecially eaijt«i;ionB flffectionH, tlm hearers, 
vehicles, of the conlaf/ittm are ktiown. In ti\|>hills it lios in tlie pus uf tho 
ulcers; iu Bntall-pox in the xerDus Ihiid, which i* found in the vehicles 
laffore tij« develupnient of |tUhltilen; in nieKules jn-ohahly in the tearw, in 
the secretion of the air-i>aH<ta|{e8 uiid in the serous contcutjt of little veaiclea, 
etc These Muidfl, €.ff., have bwn inoculated, i.e. intro<]uee(l nndur the 
•kin of healthy men and animals near the hloodvc&sels ; thereafter tho 
name local and general symptoma have appeared in the same nuccession, and 
with tolerable regularity, as in tho one from whotu the virus bad he«n 
taken. The vehiolca of the miaflniatic diseases fli-*- iKjt at all known ; thowj 
of the mii)»niaticH:outagious atfections oidy paiiiidly. Of cholera, ly|>hoitl 
fever, and dysentery, the dt;jectioiiK, and c<'nsei|uently the linen, beddings 
liigbt-vriiSt-ls Kyrin^eit, ete., may la- thi> he^trei'H of the enntagium. Tlh? 

ue i» true of diphtheria. IIi.-re the deposits on the uiucoua membnuio of 

1 palate and throat are infectious. 

Syphilitic pmi, the teant of tjjoso sick with measlea, etc., have been ex- 
amined in every way, clu-mieally and microseopically, ami no diHerenee haa 
been fuund to exist between Hyphilitic pna aitd nun-M'pbilitic pus, whieh, 
inoiMilaU^tl, comnnuiieatL'^ uo iiif»«tioij, ete. Tliime suijKlttUces hove been 
exponet) to heat and cold, and have been treated with coiTowve sublimate, 
chlorine, alkalies, etc. : their power to inft^ct ceases when the organic nm- 
teriuls have been draLruyi>d. 

Aoeonlizig to CiuuviiAtr ( Compt. ren4. Itjil. LXXtll. . No. 2) the polsouons «ub- 
ttanoe bi otmiagious liiiaicU U not dimolved. \iut, a^ uIho in the air, U KiiKpimd«d lu 
fona of small partioleR. 

The mode of origin of eontaj^ons is uiiknown, and probably differs in 
ditFerent coses. Of many efiiitngions it has been assumed tlmt ihey 
have only once been genenited, and i»fterward» have been pri)|>agated fmiu 
individual to indi^ndual, or that in ven- lare instanr<H they hud been gen- 
erated anew: so-callKil {lermoneut contagionn, t-^iuUitfut rommunirntAvo^ e. g. 
ftmaU-|iux, Kvphilia, mcasleti, cholera. Of others nniny believe that they 
aiways aiiae anew ^scarlet fever, and exanthennitous typhus, and typhoid 
ffver), but then Kpn^J epi- or endemicnlly. This assumption is, however, 
not ueceHnary to the explanation of the phenomena. The mode of origin of 
niiaauial^i is likewise litilv known. 

C-ontii;i;i(>nK ha\e a certain duration, as well as the ability to act near by 
and at greater dtstuucos. Tho duration of the material of iufectiou lus 



OOMTAUIONS AXU MUSU8. 

Iwcn denoted by thp torm (««iW/i/, hi so far hr it adlierea for a longtit of 
time to its bcm-ers. l^ymjtli fifiiii cuw-iiox can l»e kc]>t iu a dried state for 
A year nud longer \s'ithiiuc lobiiig itft power to iufect wlieu iuucitlatetl. This 
tfiiittcity np|ii'ui-H tu Im^ lougor pi-escrved l>y the rfcnivHr iKing knpt from the 
uir. Ill DXAiitht-iiiatoiitit typhus it Iiuk Imii^ii ohHurved thut in rooms ib wliich 
tliuHe uffeutt'd \\ilh llie dis*.*ittu! Imd lain, uiid which hud sttwd emply for 
uiot'L* than lievcn iiiotithK, the next occiipaiita wmx' ntfectud with the sauiie 
diMvaMi'. Tlie Kanie hiis l>ecn observed of cholera. 

With rL-ftptt^t to thf iuiuuit*r of [iropagnliuii, cniita;;ion8 are distiiiji^utiLed 
tut tixoU aiid tranaioiit {couUtqSn fisn re/ per fonUiHttm, and eonMffin hnii' 
luona vd j'rfbrilia). Ill the furmL-r uru thuso BubBtaJict-s which ure tlif metlLa 
of iuftwtioii, the Ko-cnUed veliicjys of eontjigion, Hiiid or more or Itjsa Bulid 
(|m», t'tc); in th« latter, giiseouH iMxiifK <t»x|iirei1 iiir, iwi-spinitory vapors). 
The fonner act only hy iiiiiiu*diiii>- Contact or by luocuhitiun of th<^ ix'iniHAr 
]troduct of disiuiKr ; the latter, directly or iiidiivctly, at a gii^atur or \esi 
dibtuuce. 

Fixed coiitHgioiifi are found, ospeciuliy in tiypbilis, which become con- 
lagioDB only hy the most iinniediatf! cont-iu't with th<^ Himilatit sick ; iu the 
aaiiie manner, alno, by inociilatioii nith syphilitic pus, — iii both casos ouiy 
by grounding thn akiii or mucous membranes. The contagious of mejislos, 
scai'Iet fever, smnil-pox, whooiiiug-ci.>ught diolttra, and of exauthtiuiatoua 
typhiiM, m-o trautticiit. 

la what ooaoGDtrataoa of the coutagloiL, aud at what diiitauca lufeotioii follows, U 
qa<:t<ti<iiLabIt;. Usiiiilty a uTmrt May in th« »ick-rootn U sutBcieat; or eruii iu tli« 
luljniniti); roiiTiut. in memilifH. ^m.-ill-itox, probably tyi>huii fever, and chLtlHra. In 
t>thur (bpciiKdn Moinetimo;) only a fihort wtajr in llie fiiok-nxim is dci"'«"--"-v r..r Mif.*©- 
tjon, aoittctimes the [atUM* rettults only af ttr lougcT cuntaet wilti tin it- 

ous and nlidiiminal typlius, by wliicb |>h>siciiLiuj &ik1 uudhiv espM:ifil[ ' ' '. 

A Ri(itlit>r c»u <xirive>- an iiirt-<;tkMiM JiHBntie, e.ff. Tariola, to thu (wk-nti fclia buctn, 
withuut. bH>ii[; jdF^cteil hy Hm iliiiHtuMi henwlf. 

With remiL'ci lo diplithi'tm thtTii' ar*» many iny»ilorioua cirmun«itanc<«. Acoordiii^ 
to UAKTt;l-H (/>. ArcJt.f. k'.in. JZ-W., IS(J7, C p. ;J([7j. iLi spread dot* uot nisult Lke 
that of tiio acuto cxLuthtrtn iLi from tlif tt-aiii*ints.-<i^in of a coiita^ou ftuin jf.u'son to 
pcrsnii, or it U ni the Xa&st m rhi)* munTi^r wholly uxi:eiit!oim]. In huhjiitiU B. boA 
never iteuu an iiMUuicu in which tho contagion bad Ik-kh i;<>u):iiiinicultttl lo an «icuo- 
pant of a neighboring bed or room. On tie other bimJ. the niiwl atnlcinR i-ircnin- 
at-.iac« is the persisteaoe of the diaeuae tu looaUticn, a'biob Ukewinc diBtii%niUhea it 
from the acute exanthemata. 



Doubtless iu transient coutai^ions a mediate infection i.i also pnssihlt*, i.*. 
thruugli KulwtJiuctrs which biul bo»u Ubed by the sick (clolhra, Uiipu, beU^ 
fura, etc). 

Iu ivewxal *>t !*A.xmt'5 csaniiilrs the couttiirinn of mcaak-s had boon convryed from 
a diMt«Jic« in clothes which had lieeji worn Uy puupbi who nert; lliemAetves uut *u»- 
ceptible nt the c«tita(i:ioit, oni;>: afUr travetin}; k diatanoe of fonr nttbv tn an open 
hrjot in Ktonny and rainy wuathor The same h.-uj hncn otiKervtM) in •CTnaU-pfix, 
chuWra, typhoid fever, scarlatina, tliolcra and typhoid fever arc nior.- surely inftw 
lioiu if thvir duj(.<<:tious have been for u Vtwff time e.^pu^i^d to Lhe air. (irt<?d m th<> linen, 
etc.: hence ihc frequency of sicJcm^^H of wuidiurwc>m<.')i, etc. IIuh L5 uf iui|Hjnivucx', 
on the one hand, bvenuHe LUh [ihynicinii can becoiiiti the means o[ trau»iuit.t.mt; ibo 
inf^^ctton ; on thf^ othur haii<L with n-Kpuct to mf4Kur<w in general for i>ro!<u;l)on. It 
haa also biM^n justly asserted that puerjwnd fever cai. be transinitU'l to a lying-in 
womau fr>m one sutTering from that disease, by healthy peraouB (inidwlrc* and 
pbyaieiantti. 

Individual coot.!u;iouM diwaiieM [e g. tha oomman ohicken-poa) hare a fixpd and 
tntUDJent eontJi^iou. The inoculabllity of mfia^tles (UoMR, Spkuanza, C\TtiSA. 
Mavm), and of koadut lever \,i}. Sluuk) luu aot yet been cvrtaiuly demonstrated. 



CONTAQIOKS AXD UUSUS. 



135 



he rww[»tion of eouUgions takes place, atvonling hs they are fixeil or 
ti-B-nstrnt, oitht;r Uiroiigh Um akiii mid udjuaint niticoua luciubraues, or 
through the hiiiga. 

Infection takes place throiig'b the skin and mncnns raoniliniDcs in eyphUtfl, cow- 
pox and fiimll-pox; in the former, accidentally or l>y exjicriinQtit; iu the necoitd. 
purptMuIy by iuuculaliiiu ; in tiiu third in tbu ttauiu maimer, itllhoii^b now no loiig^i 
{iisi:tiHL'<l Wliittlnfr an acicidtutal or «xpHrnut'ntal wound of Ibi? ttkiu, and especinllj 
of ike uiiirou!* mt-rnhniTi^-. i» id oJI ca8«m iieoej^siiry, in (|U*>i«ti(tiiiible in syphilii; und 
cow-pox, but vrry probublf. Infeotion tnlt<?« pinne tiivfuigh tbp liinffs. pcrbrijj 
Ukrough otbt^r mucous n)cmbran>-ft and the xkin, in inea.>los, &carlct fever. Hin| 
wboopiug-couifh, cholera, typhoid fever; tha exbaiatiomi being direct from i 
iM well nn mediate froni lh« cIoLhtw, etc. 

Many contayioiw are prolmbly received at one time by the organs of respiration, at 
Another time tjy tho»ti of dij^oHtiuu (driukbi^'Wivtcr); f-ff. thnt of typboid fuver. 

Kf't nESMEtSTKit k«;pt n sUet-p for fui hour in n (»ack with a libirt which a p^!r*ini 
kick wiLb >inial!'pox bad woni, Uit> pi»ck bi;ini( Uicii in tlit: hIo^v of umbiltcalt-d vi.-»>iclf;. 
Tb« shtep liiat iu duAiri! for food, utc., on thu fifUi day, and on the eighth day there 
l^>l>«ar1»] a well-marked eniptiou ou the JuD«r eurfaoe of the upper ]>nrt of the tbi^h. 

Cotiueruin^ meat and milk as bearers of the iofcotiouA matter of tuberculosis, titic 
in/ni. 

Conoendn^ milk an a vehicle of the iufisotioaa matter of typhoid fever, c»iiBult 
BaLlaup I'M II Im<M OutbrntM o/ I'yp/tuiii Fetw iit liUiJtffton^ truaed to the V»9 »J 
Jiitjtart MiU:. London, 1S71). 

While with reafteol to contagious it in aesmned that tlipy act by nieaiu of 
Ml excwMlingly stimll qmmtity of iiifceliouH material, a Cfrtaiii (piantity of 
it iM bell] to bt! ntice^Miiry in uiiiuiuuilii:-cunt]if^uii& uud purely miusiuutic 
diseikses, and it is huUiived thiit iliL> latter iirc dcju'iidout ii|Kiu the tiiianlily of 
UiiJB material. On this accovuit minHiua tic- contagious and niitifiniatie duwiM/s 
Rprcftd, esjiecially whi^'ii llie iitisoini ncciiiniilatea in the so-oidled Ibei of infec- 
tion, e.f/. by crowdiug tUo oak. iu dose, badly-vcutUatcd localitieK, by 
priWes, etc. 

ThuKi otinftidcrations are of importftnce with rewpcct to quarantine, which in con- 
tagiuus d(M_--iAO« (p.^. uiuaalCN, fimall-pux, nlso yellow fev<?r nnd t^mlitra.) ia nf the 
b%'he«t wrviue. indeed often fumiahes absolute Hooority, but, on the oontrorj, in 
miasmatic duteowM in iujurioua. 

In vlmt stage of eontagiouH di-seo^e the contngion is generated, i.e. when 
tlm inffctiou has readied its greatest |iowor, is only iMii>erfectIy known : iu 
tbo tu'iitt* exiintlit'inativ before nn<] tiurin;^ ibu oriijitive stage, iu typhoid 
fever aud cholera probably during the period of pi-ofuiie dinnhoia. 

In msMlea. Infection roncheii its greatest power durini? the eniptivG singe and thu 
•tag<e of elBoroacence. while during the jM^riod of iiiuubatiou and during the pro<]rouiBi 
■ kliign and thnt nf defMjtiainntion, especially t-bn former, tbii diseiiw! cinnot cpreod. In 
|Cow*p«iK tbo lymph in mrtkt at^livn from th« nixth to the ninth day. The duration of 
kivity i» mnch lon;ferunth proper preiier\-iitiun. Small-pox aud syphilid am infee- 
|itioiu M louu u puA in Hocreted in their pustuleii or nieerfi. In what stafres of the 
-•ir'.eouta&rioui* di»enM» iuft^ctioii U uimt |>»werful. ia not yet known ; In iudi- 
awa, probably during the fteriod (if active diarrhiiu ur uf diarrlju:!a ){miur- 
;. . ■•m. (ly»eatoTy. typhoid feven. With rcBpect to cholera, it i» certain thnt 

Uut lucicly thoae sick witli cholera, but tho»j KutTerin^ from a cholf^raic dtarrhtxa 
nnd not prevented thereby from ^'oiuK about, traveling, etc., can protract the dieeaKe. 
LThey do not nurd even later to have chokrn pro|>cT, while tbotc infect<;d may 
ome rick with tlie fHlly-form*d diveuBu, lUpecially ia tbia shown where, without 
: loKfit int«rcoiirKQ with the nick, thoy have tukeu chrtlera who h&d handle*] and 
[ linen tmearod with ohnleraio dejoctionn; and where a [wrHon alHicttil with 
aic diarrtiuca leaves cholera in the bouse in which be had pa«sud the night, or a 
madi shorter Ome. {PMrrruKnovuM). 



136 



00NTAOTOIV8 AND MIASMS. 



In ittOKt coses of conUigiotis or iniiismatic disease the 8|>eeific poi'son <li 
not Huflice to bring furtli the JitHJivtu, but lliere lunHt be cuu»tiit lo H8aisl Um 
poiiiou in iTacbing itn cl(>veki]iineiit mul full Hlfeci. lit indiviiiual coiilHU^ioiiii 
(liiiiEaseii tlirwe auxiliftiy canswA nmy be wnntinji, f.g. in measles aim! syphiUs. 
lu othor-a, on tb« contrary, tl»'y are essential : as in cholera an<l yellow 
fovor. Tliese anxiliavy cauwis are partly local («■■•/. tlie soil, tinetnation* 
in LliC ground- water, various relations of piiviea) ; tliey are piutly dejiend- 
eiit on the suasnn of the year (quantity nf atinoRplinric precipitation). 

k[N»Kit Hint distinpitKhflil in nholRra thn -rpHcitlR catinMi, cnpnlile nf HprRtuUng 

fm^VM plaoe to anothur. tlie cholera poison, an<) the auxiliary cauAen. i.e. thou 
forces whiob promotio and ailvaucti tbo opcratioa of the poisoD. Canaalt also tlu 
remarln below rcttpeoUos epidemics. 

Contagions, miaHnmtio, and minumatio-cmitAgiouB dtseasen exhibit a nosi- 
bor of modifications, which with equal cleanieciM and independence ilo not 
belong lo oUier and iion-inrt-t'tioiiH dineases. Tlieso modiliralions relate to 
greater or le^nr epidt^ntic or endemic |tro|^tagatian, to the iiitctiRity and 
Kcverity of individual caaes of diseitsc (mild or malignant meafliea. suai'iet 
fever, find tUphtheria ; abortive typhoid fever, light and »i?vere forma of 
ex an the ma tons t\phns luul typhoid fm-er), lo a aort of exclusion, or in- 
versely, lo alteruatiug occnri-euce, etc. They are especially found in all 
iui|>erfectly <levolopcd infectious diseases, tlte abortive cases, M>-call^. 
These modifications are most pi-omineut in smaJI pox {vwiolu vtra, mhI 
variolowi)^ in scarlet fever, diphthena, and typhoid fuver. 

Vartoclla, regarded hy sorao, especially IlEnitA, as a modification o( Tariola, is do> 
fccrmiucd to be an iuiiepeudeut disea-w (T'Iouas, VettkH). Analogwia condi- 
tiooM prolwblj ocoar also betireen diphtheria and miuij like afftfutioiu of the throat. 



In every caae an osi>ecial indiviulal nisi'osiTinK i« rteceasary for the 
broaking out of the diHwiae. This dinposition, for many diseases, e,ij. meoslca 
and suiall-pox, Vi a general one. Individuals arc nirely found who, in spit« 
of contact with the contagion, remain exempt, without a. reason for it. In 
other aHeciion.s the dis]M)aition itt, from as unknown cbusgh, much less, as 
in cholera, typlioid fever, scarlet fever. 

It is not yet ileterniinenl whether certain kinds of oraptoyment do not 
grfcut immunity from manj dLacusos. Stutistica relative to this |>oiut ute 
Ui be received with great caution, since immunity oAeu dtqiends ui>on(|uite 
other circuuistuiiwH than the want of a (specific individual disjuisition. 

Healthy and strouir jH-oido are attacked uinre often by tnfuclioua diaeasna 
tljan the weak, sickly, and convalescenl (with the exception of exanthemat- 
ouft typhus). It is not to be concluded from this that weakly and liii^ly 
persoufi do not die more eaNily when they are once lAken sick. In other 
diseases the ditfervnce is not p>.'reeptible, or the luveree Hp|»ear8. With 
respect to age. more oft^tn the fii-st year of life and partly the oldest agp are 
more or Icfis ext-nipt from infection, wkile in thciic years alao typhus fever 
and ayphiUs readiljr occur. 



i 



Typhoid fever is seldom foand hi very youoff aad very old mdividuols, tooH ofton 
bctivui-n the Kftaenth atul thirtiutb year. Scarlet fever in almLwt confined to ohild- 
hood ; it at tiinuf" attacks young adults, rarely oldor purnona. The »«atii>i liold^ true 
of diphtheria. Trao varicella occurs, a^ it SMnts, only in ohil Iriiu, ohiclLy yoan^ 
cbildrcuj in <rfder childrca the dispoaition to it appdars to Imve t)oen lost. 



tanglr dttack of the ciiaeiwe, in many contagions, affords ftlmost com- 
jtlete aecurtty from anotlicr attack : Kinall-ivox, niPn-HiM, twarlet fi-ver, 
wJioopitiK-cougli, yellow fevor, iM'rlmps also Hy[tliili8. In freiiiieiit ej>iilci(iic« 
of the^e ili«eaaea, only those of the popiilatiun bficonic alfcctefi whose liirth 
dates after the occun-ence af the hist epidtmiic ; in tlie reiiiainrler, the dis- 
[Mftition liiut been eradicated by a [jrevious attack of the di&onse. it is ko 
espfcially in meaales. 

Arwonling to Pascm, of tho 0.000 siok with mo&alos in the Furov Islnnds. not ft 
I>«rK>n was attacked a scoomi time. Ninoty-LMght old puople who had had n)(*ii&lc'8 in 
their youth, rvmalucd exempt. In the epUlcimio of jellun- fevvr nt Oibraltar. in 
IWt*. of the tl. (KM) flick there waa not a wetl-nuthentiraiteii caim of seconii nttnok. 
Only in recurrent fever, two or nmro attack!! not infretiocntly oconw. In lonrirt 
fever and small-poE chia UJttivrise ocean but rarcl>. 

Two aimilar, or different form* of contagion may appear at the same titne 
in oni- anil tho aarue individual : cow-pox and measles, scarlet fever and 
measles, typhoid fever and cholera, ehicken pox and scarlet f«ver, tyjihoiil 
fever and malaria, nioaalcH and malaria, vaiiola V(^rft and cow-j)ox. Tho 
ftUKCeptibility to a contagion is destroyed by iuouulatiou with a niodilScuiiou 
of the same coiiUigion: ftumllpos, syphilta. 

The ZYT.KT OF iXFRiTioN 18 vcry Meldiiiu accompanied by sj>e«ial sub- 
jective or objective flymptoms. In individnal severe nttticks, many have 
observefl in themselves vertigo, loss of strength, cliiltt;, nausea. 

Btitweun the time of infection and the tirst outbreak of the disease 
proper, in a stagu in which, in mont caHPH, the attacked act like healthy ]>ei^ 
sons and feel well — in rare cases, aympt<iiii» of general proHti'ation appear i 
tho STAGE OF LATENuY, oR OF iNrLHATKix. Tlie dnration of this ftiago 
Varictf in dilfeivnt dittensc9 ; besideH, in a few only, i» it exai'tly known. The 
knowledge of this period ia of great practical importance. 

In meaalefithe itnrafclnn of Incutiatinn in tiHtially frnni fl to 11 ilayR. se'dom loneer, to 
the bveinning of tho typical fevur. AL-i:<in]itigU> BiUESsi'ni.sr. tAniuilen lUr C/mnis, 
IWO, IX., p. !08). ■mall-pox has tho saiiie ptriml of incubation. The iucubatiro 
period oC yellow ferer may be onlv of one dny's 'IiiratioD. or it may extend to «er«ral 
djty. orcren to three weekn Tbnt the pcrio<l of incubiDtioii of ctmlprn lan-ia at leaat 
one week, in i*huwn nrhun ttikiUimi have UrEl liecuiu<^ Hick with cholcm aeveii tlnys after 
IpRviTjtr *4«r»-|*ort townn in whirh ch"Ier» wm prtwiut, I'sually. howcvrr. it laata 
\r,u -h^ most part twn. flVPti three wppIcs. snd lonjjer. (Consult Pkttkn- 

K- r f'h-iUm nuf S(^hiif'rn utid ilrn Zwfck d^r Q'nir<iutuhtfH. O.VUjnrJtr. 

f. .- - 'j. ' >-,'lhfi(»jijif^ge, 1ST2. IV., p, 1.) The periol of inculiatiou of tjphus fever 
Liuit« about eif^lit d.-iyx. A<x:m't]tijg to some obaerriiiiouH of BAltTl^t.s and utheni. the 
inenhative perio*! of diphthena (or croup) oectipies three day** — at le*j<t in casex aris- 
ing pxcRptinnnllyth rnngh contn^on. In Byphilin, where the cafleH are these of aoft 
<diancT«, there Is probably no incahatioo ; bat in cniieii of hard chauere there Is a 
pffotiable incnltfltion nf 'JK days (B.(Ht:Nsi'HUNt;. ctc.j. 

The period of incubation ia, fiirthermore. diffcroot. ocoordtn^ to the way by which 
the {Miison entem the boily ; thuA in vaccina and vnrioU; perhitpi^ v\m in typhoid 
ierer. 

The l.TocuiATloK of certain conta^inuH diseases deserves special mention. 
It is naturally only poK».ible in thow which liavo a fixed material of infec- 
tion (measles, small-p'ix, diphtheria, syphiliK, pln^x*). It is not only the- 
oretically, bnt also practically of the greatest impoi-Umce. 

Tuoetilat ton agaioKt lonall^poz, aa is known, hits been employed nioce the time of 
Jbnnf.k oidy a5B means of individoal protection. It is uowa>Iays on lonijerrioiie by 
transporting the contents of the pustules of caruAti ccr>i, hut ahvuys by aaing the 
lymph of ruodi^irt, or cow-pox. 



-138 



VAOClNAflON ; DfOClLATIOX. 



Whether hy the [feneral introductioa niul lefrnUy urdereil cow-]m)x umcaUtinn. 
ntU(.T contiigioiui. as KypUlIin. can also be conittmaiciitcd with it. a iju-.-nliou pi-oiKiiwU 
bjf HRBUcrHl iHiard or heiiltbhiis Lollcd forth variuus opiuiou». \'ikx>lhs (.Iir^ </c'.i. 
(fg morf, 18&0. June, July, S«[»Leiul«:ri nvniheil thi: fnllowiii); oonchtsiotw : If » iieoKiu 
be TRCoinateil with drou, {mre vacuniL- mntu^r utimtxcil wiLli blooJ. from a BvphiliUo 
person, nothing bnt ooinr-pox rcMiilt*. without CArliiT or Inter srphUitic Qom plication. 
If, oo the coiitmrjr, in the rK^t of Viwcicnting a healthy individunl with vaccine mat- 
ter from n flyvl'i'it-io iterson, whether constitutional nymptoini* be j>r<»ent or not, the 
point of the Unuvt hccoiuos spotted with blooti, thou boih discoiKa cnu be tnuisinit- 
t«d : vaccina with the vaccine matter, and *,vphiIU with the i^philitie blood- In 
tb««s case* Taooina U develu]i«:l firHt, boa»iKe it has » HhortCT eti»g9 of ittcubtttiiw 
and a qoioker development ; thu latter appears later, and reveal* itftelf at the point 
of vaooinatiou. An uloer appears here with bard borders and manifold glandular 
flwellings. 

Diirii:g the last ten years many Rtriking; exaropten have occurred of tntnsoniwon of 
sypliiliH by vnccinntinn. In Rivalta in H&rtlima, within kix wenkiii, of tdxty-thrce 
children vac-<MDated forty-atx liecame tfyphilttic tlirotiifli ttiu UHe of iinjiiirf lymph 
(O'li. meH-. lOiL. 4 Nov.. 18tJl>. A aiuiUiir thing happeued in Hungary ((jLATrKK tu 
(JSilr. ZtJichr. f. jmikt. JIrilk.,\S(i'i. yi. 4} : tUetn-aaduiothecof achild, froiu whom 
the others were viM»:inat*Ml, u midwife, wua nypbilltic. In the chUdreii which were 
Taoninattxl the cow-pox {tuML-d into pluijccdcuic ulcere followed by the ap)>«Amnoe 
of condylomata around the aunx and by alF<M;tibn8 uf the nxiath. Farther on. the 
mothcrii, and fluaUy iha fathers, IteRaino Ky|)hilitiii, m> that two years Inter, in a 
region nutnWrinfi 't50 inhftbitaiitrt, Bcventy-two were eyphilitic. 

Ex]>orim>'utiitlon by inoculation with th'j bl'>«d or Rwretiou*. espednlly the dejecta, 
of thoHC (tiulc with eh<>l>>rj. h^H m y t.-t f uriiivhcd no decided reiiults. On tbe other baud, 
it nppe.\r>< certain that auimiUH which had eutcu the exureta of chdU-ru. net iiifre- 
4uentJy. nn that aucmmt, aiokened and died (LiSDMV, TutEttacn, .1- Mi:VKU|. 

The aame theoretical and, in {lort. pra*;tical Importance hoit of late nitouhed liaclf to 
iaocolatioQ also in s^'philis. With reference to the former, the two 8>'phllJtic iKiinnu 
have been uiaed : inoculation with the wocretion of a hard ohancr« succeeds only 
in healthy individuaU. not ui thiwe who aln»uly have a bard cbaucni nr BL-rtmdary 
Hyphiliii, and (fivett riiw lo piuitulu«, and subntHiueut Heoondary nyphllth ; on the uthcr 
bond, iiioculhtionof the secretion of (toftchanoremooecflialaoin individunU uith banl 
cbancreK or with seooodarj' syphilid : it given rise to only local nyniptonis. at tbe tuuat 
to inflammation of the lymphatic irlaudn, never to ocviodary ayphiliit. lu »ittt chan- 
cre the incubation (Ktriud ■» very nhurt, in tbe hard variety )Li durution ib about ottO 
month. Thiit dimilarity tH.-tween vofoine and soft chancre on the one hoiul. ILn4 
between variola and bnrd ohanora on the other, an well a» many other relatiooK not 
here diiicus<sed, atfordu a reason for the inoculation of it,vphiliK. not merely on theoret- 
ical and dia^na^Mo grounda, but also for the purpiiic of cure : either to cure nnly, or, 
indeei, for the purpc»seof prewrvative or preveotive syiihih^ittion (AC/.l.v't-Ti-iucssK, 
Mabcii.vi. df. C-it.vi, SpKUiN'f), RoHiiKj. The former wo-s tried only with tbo Jiyph- 
ilitic. while tbe hitter should Im extended tu all men to prevuut primary and necan- 
dary Bvphilia, 

Bk&to»»i:au. UenriN. and othen include diphtheria also among the Inocnlable 
dinoaMa. And yet the practice of inucaUtiou would be of no value, since diphtheria 
can aitnok tbe aamv individual several tJiucB. and iiiuee inoculaliuu doea not ensme 
a mild grude of the diseiMu. 

Tn mianleK and Kculet fever inociiKtioQ hofl, until now, been omli^rt^im only for 
tbeoretic-nl, not for practical roaeons. Tbe inooolatod dioeaBo was much lighter %1 
tbat Doontring in the nsnal manner. 



TUo spofial bviupluinHtolo^v uf irifcctioiiB diseases belotigs to sjiecinl pm- 
tbology. In geneml the sYiiijttoiiis tn^ii in eontsgiuiiii (liaeawK, Mitui.*(initfft 
at the pouit of rticfption of the contflj^iiim (paiu, rotlwxw, exuiiaiion), ikhiu*- 
timos as a getii^ml aiclcm^u. All diseusea of tliit ulasa are uocoiujmuird 
jMirtly by high fijv<;r, [tartly bv alTfuliuiib of Jetinitti tiKtiueti aiiU orjpuitif 
es|i«ciaUy of the skin tunl niucoua uioiubntubH (vont-agious di^'asi^s), ak well 
H8 of gUmlular arguus, and copious ovucuatioua, or by l>oili. Tko 
CDuruu uliiu of inoftt febrile contagiutia and uiiiiHuiniic dioeaBcs in unich 
more regular than in other Jiat^i^ies ; in all acuto fubrilu infuctiouB dibtinaes 
it is statnjicU with a cyclical chamctci'. 



I 



4 

I 
4 







GKOCiUAPIIICAL DI6TKlBL'TION, KTC 



139 



With rtapect to coiitHgiuhH baiiI iiiia-siitH, llieiiGECxiRAriiirAL DiaTKiBi'TioXf 

Itfts wt*U as tbt' inlluuuct-> wlilch sutcinl rHhiticiiH fxert ii|*mii their i>ociin-euci>, 

are of gieat iiii{K>rtuticts AH tht-Ku circiiiiiMUinci'a hiv iiiipurtaiit, becaiisv 

they turiUMli iiifonniitioii cuiicLTuin^ Uitr |K>s>vi)>KMi)itiiiv uiit) cuusc uf urigiii, 

C'bpuciallf of uiusxaatk' aud luiusoiutic-coatagious dUL-ases. 

Aciitu contoitious dlMftSM an, us it Memti. spread over the whole earth, axil inde- 
]vu')i-ut]y <jf uitcuiRBtajtoeiiof race, cliuuit«. 8^)il. etc. The K^n^niihical (li^t^tblltioD of 
I- .1.1 eKBtinliuUy depeiitleut upuii lliu exU-ul t(i which v£M:OLJj.i:ii:iu ih iiruc-tlHuJ. 

] I mnr« often imx-utv in ihiup aiiil »wmii|iy lucKlititM. Miuiy niuiMimtics- 

.,L,.»i.-...ti iliscAHM, *<.{/. jL'lluw fever, i-holoni. t>'jih(>i<t fever, are inoru or ItK* ilt^[Min- 
f dcut upon ilic oiFcunuctanL*cti nlnjiaily AlliidtiMl to. Thus, e.t/. cholera, ulou tvphoid 
fevvr, arise opon a poronB I'olhiviat) »oil, nud appantiit oxo«ptions arc expluiuisd by 
the fact that tho rocky siibstancc of a loealltj in not compact, or is covered hy a lor- 
fsce of iwroiu! ftoii Cholera spreoda prefemlily idou-j the banks of riverf ; yellow 
fever, ouly on the coaMlH or >»:ikH of great navi^nlilt* Hlri'HiiiH. Minntimtif: mohtrlnl 
I fevHnt prifdnminate an ptiitnK, their inteiuity uiiil projuigatiun Uiiug pni|H)rtioimlj^ to 
tbo mui»tiirc nf the »oiI and its rcadiofiui to dry. aUo tu its vnryiuff tiiolitiiire. 

Tho iulluiuiec of the tkmi'uuati hk ok Tiiii aik upoD contngious. aud ei>pecially 
upvu itiiai4iiiiitie iiud uiiuxiiiatiu ooiitutfioiiM diM-ititos, is ul great iiii]Njrtjujo.>. Thua, 
aniiin^t HK, nudarinl fever Appuani in the npritig oiid early »uiuiuer; ty]>huH aud 
typhoid, ia late aummer and aulumn; cholem, pnrticulnrly in Hiimmi.>r. The iiitlu- 
eac* of tho veoaous oorreeponds in part with the tennwrntnr*;, and yvt in the eKtinuitA 
the uiuisture of Uie aoil and of the air are of the greatcat ooiiBeqaencv. Thiu 
especially ia eholera, typhoid fever, and iuterndtt^iiC fever. 

R\CK AND Nationality liavu a dcddt-'d inllu'-nci- uu tx-rtuin mioftiiiatio-ooutagioita 
dtKcoM'H Efipecially nuteworlhy iHthe idnioxL complete imiuuuity of the uegro, aud, 
in a letts dr^rv<e. of t-he mulatto Trom y<tllnw fRVRr. ThiB iiiimuitiiy in ill part uertaiidy 
dependeut upon accJitnation, Htnoe a h'ng residence in c^ild regiuiia luuktv the uc(fn> 
ahio suitoeptiUe to the disoa»«e. 

The i>Ki.ri';N(-i: of acclimation upon the miaainatic-coutagioDi disoaiieti ia 
shown ill hi^^h dei^ree in yeilnw fcvor. TaiM dinoawi oocurm, hi those regioiu where 
it prpvuilH endemiirally, nlmuBt HxcJuHivL-ly nmong thtwe of short n»idcu(» or the 
unacfliinatcd; wliile. on the other haud, th«j nativen ore alraoHt entirely exPiinpl. 
lu itilluriiza u cuoiplele exempiiou hua often been olnter^-ed in the tinacclimatcd. 
The ifinnmiie ha» been otjuerved in uholeru, ^.fj. iu CalcutUk. 

The INJ'LIK.NCF. OKSL^crAL rm.atiossou txutagioua di»ea»c» IS nmoll — if that pro- 
tectitia IB cxclndoil which tho wealihy can provide ihtmselve* with by a ohaugo of 
residenee, or by complete isolation from tlie loealities of the eptdetaic, by vncciuatioii 
[ in BOioll-pox. and by the varions meomireH employed againfit iq^ilia. Thnt iullu- 
, once, huwever, i», iu most mia^malie coutagiuuH discriACt), an altogether euperior one. 
Ah!u it thv bmiceptibiiity to thusu di)tL-u><LH i*. uu the whole, n gcnci^al one. then are 
individiialH in uufuvorubie circuiiiKt-unct;.H, otc., e«|>ecially cDHueruud. Thub yellow 
fever pn'Tatls almofit exoliwiv«ly in plaL-e« witii a crowded population, €ii|>ecially in 
jiopalouA cities, while the country p(^>oplt< and L-veu thoKe of the imitiedinte. iii'-i(rhlH>r- 
boo'l of tlic eitiea are exerupc. H o<?eun« e^ptieiidiy in lilrty, budiy-ventilatfd. damp, 
iiarrow (■treelK, and which are covered with auimol excreta, with high hoiL^ea, uud 
dcnaely inhaliitt-il with n poor poiitihtliuii. Or, hen; it spreada faxLbcr, ia more luulig- 
xmut, and renmiufi Imiger. Cholera ittUu^ki* prufi-Rildy the poor, needy, uud htrug- 
ptinf,'' part vl thu population, the wt'althy chi»teH |)artici|iatiug to a pruportiouaUrly 
niiiall extent, exi:e]itiu the iwTerc^t t*pideniic». Typhoa fever haa no iucrwised among 
the Irish pvojile that all kanitary meiu'utet'. have uiitil now been instiOlcient to exier- 
muiate It, ur to pruveuL it* duvdopiiii; iucruaiiiug forev, so that it clings to tlie Irish 
emiyrant an a oar*;, aud follow* him e\erywhi;re, wherever he tokoB with bini tho 
habiluoJ erilR of the life 'if the lower ulawen uf hi)« homo, tiociul evdn (war, 
' tailtire uf cnipFi, famine) are in t^-]>hiiH au'l typhoid fevens ef]»ecially the former, of 
[ ^reat inllueuee. Ewpocially i& thi« tni.? of Ireland, where lyphua fever re^larly 
kppean after faUuro of the croji^. Thence it exteadH nito ttm KnglLnh and 
8cvttuib citiei), M-hcre the ludging hiiiuie« of the Iriidi and their dirty liuta are 
crowded together, in which tne diKeaso never diea out, and fmm which, nndec 
favoratile elrL>umatancc«. it radiates to n vahaUe extent into the neighlMjring luculi- 
tiea. A simihir stale of affoirB in found in Italy. ;n I'olaud. and Upper Silujiia, in tlie 
Baltic province* of Buuuia, and in certain di«cricUt uf N*orth-we«l Germany. * The same 

* TypboA fever haa ucourred in the itriiiuipai citieit of the United StateH (especially 
ftloug'the acabooid) at Tarioua fcimott daring the paat forty ycara. — Bd.] 



6P0BADI0, ENTtEVTC, EPlDWK) DIBBABES. 

unriiU cnnititions were fnnnil m tli«> tmxnW cpiflpmicK in Brrlio, Hollti, Jjt'iyttiff. tte. ; 
amonfT the Iroopi of tht* wf'stom powprs linnn^ the Criitiuan war; nnil in ifciUt«K! 
localities, u prwins. botsftital^. in^tiliiti'ina for tho poor, cto. TxphMid ( . / i-i 
obicrt'od (wpeciiilly '.■fu-ri in ilninp. nnrrow, dtrty strcc-t* and hou«<'i!. i;i i\u '■■ 

rendcrt'tl |ke«tiferuu!) br all kiu<j(« of etlliivix lu over-i>o(>ulat<Hl. ol<J, tinlf i !1- 

ing» ; oocurring iqioniilicalljr luid ci>iJi'mi<*i»lly. It oocun ileriil^lly uv 'a 

]ftr^. over-i>opulanii riiiex Ihftu in tlii- lort-I irountTy. It uoncenii* in i\ h\i' 'ft 

T^c iinmi^rfiot nfter a few raonthn' reKidencA ; the wi cnllnl oci<luuntiiiu twer. 
DnriDg' tbi< lotit tOD years Msrund tnetauccs havo been commanlcaicd where il hu 
iilLjckcfl wbuli! dtrtuU ur iKirliuiis ut n uitj*. etc., iu c(iiuH.M(ueuue uf the water supply 
retidvrvd impure )i; itif^cLiouM filth. Social evtbi hare hAit the same eMeutlal inda- 
enoe od the Orient«l pln^c. 



An impoi*t4Uit pecnliarity of conta^otia and miasmatic diAMBea coniiists 
in this, that nmuv npptiur iUmoHL putirely iu a spuraiAc iLiAuimr, while othiTi 
are ut the kiiiio time trnd i'8»(*iiti»lty cpiilrtuic nu«t futiciriic, Thow divost^s 
are called sronADii; wliich attack iiidiviiluulH irKlr^teuili'iiily nf lime aiid 
place. On the otJuT hanJ, tbo»p disi'uiu-s ai* ciUlud hpicjKMH' ■which attjtck 
a number of [>cr80UK at ihu same timt.', i.e. on the eamv daj. within the 
same week or month, lunl in tlie same immniT. If the pestilence spread 
over a whule cuniitry, or, at the Haine time, thrv>ugh a whole jKtpulHLiun, it 
la citUeil i>ASDBMk:. if, finally, the same disease he often repeated in one 
locality, it is called endemic. 

The esseutiiil caus« of epidf.mii.' birkases is jMirtly unknown {^.t;. oonta- 
giuuH and miaaiiut) and partly known. But wo mast not claim that iu 
every opidnniic itn CMtculial cauHiU nonditiou can he with eertuinty iSKtab- 
lished. 

The canse, for example, ia known of the epideniica of trirliinoais which 
have lately excittnl bo mufli iuvi-«tiji;ation ; which cause, as far uh itn hptfad 
lias beoti ohservt^d to occxir iu a ct*rtuiu locality, has been termed endoruic 
JIofB or Ip8s known alao is the cause, by colli, etc., of rhc'^umatiiim, pneu- 
mania, irysiitelas, whtise ap[tfaraiicv is riyhtly caltwl epirhjuiii: when they 
atfHct a lar]^! number. The cause of luauy epidfmica of typhoiil fever is 
likewise known. 

Every epidnniii; ahnwa a jwriod of iucrenitp, of full developnirat or hvight, 
and of altatoment.. Iu most cases the inerease ia rapid, tli*^ heiglit im aoon 
ri')i<:h<;d, while the stage of uhaieuioiit in mmiewhat prohmgod. After its 
departure the disease hiaves no traces, not infrecpiontly di.sappearintr inriri'ly 
for miiny years, nnlil isolated cases suddenly announce the bt-gimiint; again 
of a uuw epidoiuic ; nv, diiritijL; the pans*: it may fxintiii Kiu;;lr, inicunnci-ted 
cawes, Bporadically. The fnrnier way is that of cholei-a, uRunlly meiwh's also; 
tiie latter, that of Boorlet fever, espeoiHlly in large commuuititn, us well aa 
of Buiall-fwx 

The duration of epidoraicR prnj»er varipa greatly, usually not less than 
from two to three mnnths, and seldom exceeding a half y^ar. In those di»- 
cases which are nt the same time endemic, the duration is longer and their 
retm-n frwjueut and almost rt>gidar yearly. In general, tim duration of epi- 
demics is lont^-r iu Iarf*e cotunmuitics than in smaller localities, WcauNO of 
the numrii-ous points of contact of the cAii!4e of the disease with individual.^ 
capable of infection. This applies to miasuialic alfoctions, so-called, hut in 
an esjiecial manner to thnso of a conUijious nature. The duration ia sboti- 
in epidemics, e.i/. of uiwiHles and cholera, Inugcr in Rcarlet fever, sn(alh|ioic, 
and typhoid fever. 

The greater number of epidemic diseases are constitutional ; only a few 
are local troubles. Among the former are found, 8.^;., all infectiuita dia* 



0HAEACTER6 OF EPrnKMICS. 



141 



— MW, as typboid fever, cholvra, nmtc exnntliomnta, roalartoaa diseases. 
KevOT is pRtMTUt ill most aH'i»ctutii« wiiieh tqn.tnir t^|<i^I«!rijically. 

The Rpn-ail uf au epidoiiiii: lak«:s jiIjut in s«ivcriil vtnyn^ according as the 
dtsfMHO i-s o^utn^ous, or is uut cuutugious. In thu 6mt instance thei*e are, 
ofit'n nuil^r the iulluenro of local ciiTiuii-^tiiTJCes, iium*-'rous siu;jlc, more or 
lev* caii^iidt^i-Mble foci of ciJiiUigiini (hjiu wJiicU tlia diseiuto iigniu ttikes its 
tl(f|iHrture. Tliiis are dtHtiuguishcd tht.- e[iidoiaics of Rtro^ti:, li(iii5e» lunl 
r<>'>nis. Tht? Jui'iise pii-vailii tjomeUitR'H toward the and of au epiHeniic in 
a [lart uf a locality akojjether ditrcrcut from that in which it began lit 
the second inat^ioc, thi> individual caaes aro scattered alioiii in the atfectbd 
populalion without such oMer. 

Au e(ildurotc exists in one community only, or in a few neighboring com- 
ninnitit^ hut in ita greater extension, over a whole laud, it is called a PAN- 
DEMIC. Pandemic exUniaion ih often auen in eluilera^ malarioviH diseases, 
BometiineK in typhous (Iisca.srs, diphtheda. A jwndemic is always made up 
«f numeronRse|ini'ate, large and not ooiil«ni|iontne<mn epidemics ; its duration, 
thvi-efon-, is variouH, but ia for the mof*t pari very lonj^, often extending 
over many years. 

The lUMtntATK cause of the epitleinic spread of many diseases is al- 
nioM wholly unknown. A few arise in abnonuul circiinistancfrti of the 
weatlier, e.i/. hronchilis and pneumonia in ften»mR with frcijuent. raw winJs, 
tronhh-s of the ilit^estive orf;aiis durini! grfat beat. In the geaei'ul exten- 
sion of the influences which cause sickness can be found the cuu»e of 
numerous cases of disease. Again, an nlti;^ather similar weather may 
fXiMt At other times, and yet diseases of that kind lUt not appe-^ir in 
greater uumher. Tlieie must also lie something prest^nt which is essentially 
cvmc^rned in the origin of the alTection. Other diseases, e.«/. meaaIcK, gener- 
ally attdck only once, the individual }K-i'meat«il by the contagion bring fi-ee. 
In greut nxteuaions of epidemics of men^les, there remain, after the de- 
pttTtnre of the disease, only a few individuals who luive not been ex|)osed lo 
tlie cause of nieaslcs. The number of those increases in the following years 
liy lueaus of births, and tluui there in at last an abuuduut material for a 
pew epidemic. Why it ap^^eurs at one time, nnd not a few months or a half 
year earlier or later, it is impossible to t*fty. Still more remnrkuhle is tlio 
growth ijito an epidemic of other diseaues^ e.g. cholera. Here the yerni 
has often l»een conveyed into a healthy population for months without 
fspteial consequences, until sinhlerdy tlie epidemic brenks out and runs its 
uhihd course, while in other localities it immediately follows the first case. 

From such observations it folJnws that not only the causes of disease and 
the indiviiluala to be affected are netvssary to the nm! of au epidemic, but 
also that there aro necessarily other and auxiliary causes. Theao latter 
jmrlly inllueneo the causes of disL-ase, partly the individuals, partly, and 
lit the same time, both. Tlie former ap|>ear to increase and spread hy the 
agency of auxilisry causes, while in indiviiluals a change of the constitu* 
tion hitheito unknown prectiloa, in consef|uenoe of which ojferation of the 
CJiu.^e of the di^ensie ia [>o><iiib]e. Such au assisting cause we lightly assume 
to exist, fur examjile, in the water fr-om the soil for typhoid fever. 



For the development of an epidemic of cholera there must bo, according to Pet- 
I T' ' ■ ' "■■ i: : 1. An inhaWtcil hoil iR-rmcablc to water nnd air to the depth of the 
!>d-nutvr. 2. A lliictiiHlioii hi Uiu luoifttiiro of thii Htratiiui, whicli. in the 
, cirriTsponils to tl>« var^iny *itnte of the uiuIetTfnnind-wftU!r, diirtnj; which 
tliL' tJinu of thf> falling' from au uiiuqiiitl faettfht mnrkx the timo of dinger. H, 
Th«? prriMiDOC of oiKAiiio mattent, esjieclall.v those haying their origin in excrement, 
which mstlera hare buen diffuBoil in the stratum of tJie soil susoeptihle of it. 4. The 



OHAR-lOTEia OF EPrnKKIOB. 

(i]>e<iific germ pTOpngnteil by hnman interootirse. th«« pjwrlfic caiwr of cholera, the 
chiuf bearer of which in the intestinal nxcremont of thoBe «ck witJi cholomic lUarrhfxn 
luiJ iKMBibly lUso of tby healthy who wmo from looaKtio* iiiFoctiMl by cholenL 
■*>. A rliK;M3Hitiun of iiidividunU to I.M>onine ftick with cboLera. This viefr of 
Pk'ITesivokich'h htut t«ceiitJy found luauy opponont* iBicnKEit, Samdkii. au'l 

Bi'lll. hoA ahavm that tit Munich » sinking of Uie »>oil water m attended with an to- 
oreiue in the DurDlier of th<Me aiclc with typ'toiil tuvnr ; itit rinp, with h iltiuiuatioii 
la Dia niimVr of tbose oaiev This he csplttLnt In this w.iy : hj the slDkLnfr ot the 
H'iil-wiiter l.h<! fttrabi of thu KroutiT opt fui- l,'.ia [;jU')mtion of the immL-iliat*:- cnmie of 
the ferer coine* iu cim*T)t with the air of V^i xarface, llirmsli whi';h mr thi; irihnhi- 
Muts of thfl citjr am bron^ht in contact with thoin ciawn. while by thv rifw? of the 
hdII ^t'alcr the ctntr-iry tnk<i9 plnoo, Viriciionr haa ahowo the BAme for Itorlin with 
rwpuct bo typhoiil fever. 



TyphuB fevpr, rec-irrent fevf>r, eholei-a, ure, fiirfliermr>re, iilisoviftf) BspncinHy 
afTiTtiiig the p Jar, while m^ialos iin-l scarlet fever ait'-et e^iualty thf rith nwi 
the jiosr. Honco it app^rs thiit peculmrittes m.\y be ^enerutoil vritliia the 
bMv through favorable ami tiiifnvor.thto extr>rtial (.>irciiiiiMt«m>'^K, which are 
nseutially nonceruiul in the questiuii of origin of Sjmratlic, aud c»|i«:iaUy 
aUo uf opitlemic iliKnaaea. 

As little is known concerning the origin of epittftnics, so uUo do we 
know little concerning tho «ium« of the consiileriiUk' thictuutioas during 
the clirniix and stwge of decline, aui] of the canses of variotiH dt^grwes of 
intonHity of the same diabase in the cotirae of a single year. It uot infiiv 
qtiently happens, that certain davA exert an nnfavoi'ahic! intlm-nce by their 
extreme tempei-atiu-e and extreme flnctuattoua of tein|»eratui-e, or by other 
eirciiiaiit:incos of the weather, e.ff. violent ratn-stcmift or thiindt^r-stvrmai 
while altogether similar circnmfitancea on other days ai-e observed to be 
wiihonl iutliioiice, or are olTective in an apparently opptpsite inauniT. With 
reaiMsct to this nothing certain has to the prowMil tiiiio Wen offered. 
Similar relatione with if>s|)ei^t to the coui-m*. in iniltvtiliml eoKf^M lu-e, how- 
ever, also rnBti-ictc;!, sine*.' other ami moi*e or less complicated forces always 
come into the account. ThiiH, *.y., the inrinenctf of tlie season of tho voar, 
the inHnenco of a hypothetical fpialitative dilferenco {energ\ ) of ihr ai>e- 
cific eauae of diRoase, of the different eonstitntiona of individuulK, thi* in- 
fluence i»f certidn prophylactic nn?usnii'S, etc 

The KATKssios OF KPiDEMR's sometimes tluctuatee in a very conaiderablu 
and apparently t^pricions manner. This is secin mont Rtrikingly in the 
various local epitleuiicfl of cholera, ^^^^asle8 (iomctimi^s apiM^ars iu a very 
inooiuii<lerahle L'[ii(Iemtc, to ap|>ear again after im unu.sually short interval 
BO miicli flio morel violent. More explicidije ia tlie very variable intviiaity 
of optdetnicii of int^mnittent fever, which are hen^ drterniinei] by the 
quantity of moisture in the nolI. An exphination of the ditferont iiitcDfli- 
tiea iH in any owe to \ie fonuil in the ein-umsttinco, that for the production 
of an epi<lemic^ not only one but jMfveral n»»i!iting cauHtia acting iu the nio«t 
vanous manner arc nect.'Ksaty, that theae exJHt nt the same time, akhuugh 
not nocosj*»iily ho. 

The MOKTA.LITV of epidemic dineases is as changing an their spread. In 
Borne epidemics all caacs i-ecover, in others the |»ero«ntage of dft:ii)i)t is very 
considernbic, and, ton, without any definite perceptible cana<.> for the diffei^ , 
once. TliUH it is eKpecially in Kcarlet fever. Some authors have att«tn)i>t04l 
to ex[dain this by aHsitmiiig a ilouhle cause for the sickness, a.ssuming a . 
mnlignant and an innoxious form ; nevci'thi'lvHa, they hnVL> not yet \tfir>n 
able t<.> say why soiuetinies the one form jirevails, and at other tiuK<s the 
other form. PerhapK nuJigiuint epidemiua are tu be exjdaincd by the 



^ 



'cnAnAcrnnff'by ftnoKMrcs. 



143 



■ifltancows presrucc of Hnfovoi-iible influpiicps oiid sfx^rifif; nifltr-rial, wliio-h 

t in an tiifi-ciivt- injurious inaiiiior those airk tlirough the pntvuiliiig 

fjiiileniic. SoHietinn;s a iiiarkeil »|)rfa(l «inl ofleii ain't mortality,* in certain 

**)ii<teiiiio tlis ui'^t.'ji (s&»rlut-fv*vi«r, iliphthcria, tjiihoitl levyr) arc conliiUMl to 

fMif,:h^ fitiuities. 

Ununlly they are the most Bevcrfly sick, most frwiuently killer], who are 
nttAcked (hiring thu Hr«t half of tho eptiKiinic ; later, there in an abat^meut 
jof iJie intensity of the Hyniiit^jins of thf! tliseuse. And yet, indeed, vei-y 
~ ivi-rc casus not infrequently spiwar, like Btnigglcrs of im epidemic. 

MiLny, or at leuftt two, epidnmicA ctm iirevai) at the uanie time and poB< 
»ess a tuluirtbln inteuxity ; ihtiK, r.r; , scAilot ffvrr Bud meaaleK, chiefly the 
acute exAiithetuata, cholem and typhoid fevur, cholei-a find intpiniittciit fpver, 
whooping-cough and brouehititt. At otht-r tiuicfi, for unknown leuRons, 
oilier epidL'inie ur nou-epid<.'inic diseuses diitappear during the prevalence of 
a single KfKTiidly f^xtetuh-d epidemic, to I'eappear agaiu after the departure 
of the epidenji<.\ The tend«'uey of a population to become fticJc seems in a 
cortAin loooaure to be destrfiyed by a great epidemic, for not infi-equently 
afUri* itft dp|i«rtiire there e)ciht« a gorwl tvudition of health fur a long time. 
It is true thai in niurderoua eiddoniics (r.f/. cholera) this miiy dejuiuj 
i]pon the fact tJint many Aick ppi-Kons have been swept away. 

As hiu* already U-en iiitifimtt!il above, the PftOONdHis of epidemics of ono 
Mid the>yune diKejise may Im; vt-ry dilfereiit. Am! nut only temporarily can 
a coiiMderuble ditfrM-eiicc arise, bur. it in often found also in epidemics which 
arc contemporaneous, but affecting ditf'^rcut localities. it haH bet*n 
oltaerved, es|»eciatly in measles, that the disi-mse ui larger [daces wliich have 
luort* frtwitieut opidennes, rvin-s a miUler course than in anialler jilaoea, in 
which it appears le&s often. 

rHopHYi-AXiu LB of the greatest import«nco in epidemics. The aim of 
iulo[iting public measniva with n*Kirect. to thia, is, on the one hand, to 
increiiKe the ability of the |M;«ple to resist itijurioua causes of disease; on 
tlte orhfT hand, to destroy them and n^ndt-r thi-m harndewi. This end is 
reiichcd by ch:aniug and vcntilnting phicen of abode and their surround- 
ings, by procuring giKHJ drinking-wati?r, by supplying tlie poor with food 
aiid •bflliiiig, by dihinfectiiig sifk-rooms antl the liiu'ii of tJie wrk, by 
^tv iiinoxiouR the dejecta whicli wo often the bearers of the cauweaof 

^^%i- v removing the Mck fiuui their unfavorable dwellings into proji- 

erlv uiuii'i^e<i public hr^spUiils, by aepai-atiiig the healthy frotu the neigh* 
borhoiiil <jf tho ffici of inft'Ction and by desli-oying such foci, etc. 

E>DEMn"s, nndor which form diwiasis pmtly acute and pRitly chronic 
lipjH'ar, dfpond ujion luca.1 pecuUaritieH, which someliine<i are the char- 
acter of the soil» sonietimcH local iv-jnUilious and custouis, sometimes they 
rvKtdt from a certain abnomnil tpiality nf tho foiHl of tlie commnuity. 
Finally, there are eudemics which ari-se from no known causes. Kn- 
dcmie dJKeascB ap|>ear jtnrlly spormlicolly, and SDmotiiuea sporadically aud 
epidetDiCBlly. The tendency to them in the aifeoted loc^dities can in any 
case \tc increased by anti-hygienic conditions. 

The Koil can be the oaase of an endemic by being the bear«r of the cause of 
dlaeOML Thus itt it In mimy localiliCK with typhoid fever ia tbir fall, ami in tbe 
TmriouB fumiii of malarial diwjase. cboleriL, plapii;, yellow tvvCT. Tlii: Inltcr, at first 

vU'tnii} in a nion; or lc«v« limited dL->triot. »|>rua(l out later Iiorotiil tlu'ir confines iuto 

iteiKled epidemics. CtftiuiBUi, p^iitre, arw moirt i^roluihly endemic throngli tbfi nature 
'^of tbtf coiJ ; both Ftnud in n relation to cTninmio intrnnitt<-Dt fovor. 

By moons of aoti by^enio regolatioaH. tjplioiil fcrcr, tuherculoaU, Borofnla, as well 
naasauiuA. chlorosis, rachUis, hare almost become end«uuc diacoHi In aeulj all great 
oiciea. 



U4 



EpmKMic ooNaTTrunoNS. 



An nbnnnna] condition of oorn u th« CAUse of Pellagra in Upper liidy. Mftnj 
panuitic ilinrMtitoii bcofiue eiulemui tu 9om<> l<xicUiti(M od aouount of tht: ftbiiormaj oun- 
dicion of importAiit articlfiK uf fooil. t.g. of curuuu kiuiln of uieiu. Cont'tiuiuatjou 
of drinkinjr-wnUr oaoiwis in in:uiy placfn, cIumIIj" hi tbtiw not HOcurtomeiJ t-i its uue. 
eudemio jnl-oitkniil and giuttrio dinoMun, probiiblj sumetJiac* alsi-* tv)>hoid foviT. u 
well iu> iiifecticm with ilnthry^K-riiJtitl.tui oiid AiikJtltvtOimiitn An uhuorual quauUiy 
of itri nnrni-.U ingn>dieat«, e.g. Umo, u MiiJ Ui Iw the cauw of iniuiy ulTectiotui in a 
uommunitjr. 

From more or less nnlmovrD canses nrifie endemloanj, e.g. , in tniinj localilioa uid 
conntries. dipbtheritic AtTcctionn, caroinociifi. oueuriMUH. plica Pulouiuo, And other 
affactiuiiiL The formerly iiuktiown cnuMis of luaii.v cudcinics havu latulj* been Qlwred 
up, tu), en., the nature uf ii furm uf liicmutaria ubiMTTttd in AfricA, Uirongh the di^ 
oovory of a pnrjwite, xhn /H*t-"in"»n fur-in-tO/f'i'iin (p. 121). 

OF-HTEaLEN, Di< ikuchen^ Are i'/uhtch(ti, Gaeiv and Bt^utanfuny. 1873. 

El'IDBMIf, EXDEJIIC, AlCyUAL COXSTITUTItiX OT UI&HASK, EPIDEUIC ClUaAO* 

TEK OP uiSEAHE ; geaiu4 eplUmicu* : aro oxprtissionH for the strtkuigly 
frequent appearance uf similar Uiaeaiies of a uon-oontagioua or mituMiiatic 
nature, of diseases tNjuully iauoceut and iiialignaut, and for ihu strikiiij; 
auccesiiion of imlividuiU sviuptoius. Heretofore, with resppct to this, 
nothing serviceablo could bo brought forward, because of the false rievrt 
and classifications of diseuses (intlaminatoiy, rheumatic, gastric, biJioufl, 
nervous, aiiiciuic, Hct;)rhutic-]>utrid, etc.) wliich were at the foundation of 
the older ubs'jrvatiuTis; ill Uter limos, howovcr, these uiatlers have ui^uatly 
received do attention. 



The foUowitts; epidemic constltutioiu hare been dlatioffulithed : 

a. TIjti inpTaMMATOKT epideiuic prevailit prefL-ialilj duriug the provalcace of a 
low t<!m[Kr»iurR, an tu wintor nud during uolil ttorth wiit<l>i, in dry tiLmoftpbore. It la 
ohBraKtJr^rizl'cI liv inllamroaiiotiH, for the mmtt part thoM of the Inngs. 

/'. The .SKAVoiiii epidemic constitution prcvjiil^ dnriugopprepdre boats, aonroity of 
water, foul atmosphoro, as for the most part in the uummer. and is cbaracteriiefC byr 
fonnn of disease which appear with important pbenomeua ooonttcted with the nerroaa 
system, and which are aatheuio in uharuelur, etc 

t. The AS^MtcvpidumiccbaraetenztiBduMuses which make their appcoiance Dooom- 
panied by nympUiuiK of unnrnta. 

//. The ijAsrrKir epidemic character in developed in those ■eoaonx of the yoar In 
which heat and inoiMCure prernil together. It dispcKiesi to affectioiiH of the digestire 
apparatus ; further, under iu inllneuco nriMt cyphona diseaacR. To the gaioric ui 
nubonliaated the bilions epidemic churacter of diaeaso. whiuh in very hot aeoMOUs of 
the ye.-Lr dispoees to troubles of the hnpntic system. 

«. The I'l'TRin epideniio conntitution makee its appearance at each limoa and In 
those plaoeH whvre, during moderate hc&L, great iiuoiititii's of orgaoio suhatunces i 
pntrcfy. an hnf. been observed after great battles. Dixoaaes thna ori^icatinf have the 
Rejitic character. 

/. The CATAURlTAt. epidemic character oocniiiona dinoases of the mncnn" "^••' 
etpeciaJty r>f those of the organs of reepirntion and of the digeit ive ontir> 
at the time of uhangcii of the weather, cspectaUy if oold alternate with v. 
the ti)iriug and autumn. It prevails also in tnoiiit cold weatber. 

g. Tbti nnEuidATic epidemic constitution, which amoa from mdden chang«a of 
the temiM^rnLuru dnring pru\*ailit]g windn, etc., dispones to thoae forma of dtwaau . 
which orp ik-^i^nut^rl liy ihL- nneu*nn rheumatism. 

(.According to llEtcn,' Lthrh. d. M'gtm. ^iitict.^p. 2S7.) 



OENERAr. PATIIOLOOICAL PHYSIOLOOT. 



145 



PART THIRD. 



ERAL PATHOLOGICAL ANATOMY AND 
PHYSIOLOGY. 



(Study of local db(tuTl)viee8 of the circulation, and of nutrition.) 
I LOCJU. DISTUIIBANCES OF THE UtBCULATION. 



rEDEURTKU, Vutfru Ah. tf, KrfvAwf il^ fSi'tai «. uitfn*. ith itu Bncfgung f!a». in 
ii. a. It'uinjpf. IHJ-^. — WiLl.l\Mi». /i'^'A. *Mf Uh ot'infji Hu ntaue. rfij fiuf/ it. 
fa urUti. etifiUl., ISl'i. — Di!R<ns ((rAraicnj*t i'rrU-^onji lin ptit/i. frfirr., 1841. — OltlK- 
STXOKK, Art/i. /. j'ftj/*. Jf'^lJi., 11*42, 1. — Hkiiumann, It. Wiiffwr'ii H'lut/u^. ft. /'Ay- 
»wL. IiH4. 11.. 1.. yil.-Ei). ifc K. H. Wkiiek. }f:tU,r-» Ardi.. IN74. p. 333, 
lS5t. p. 407.— Lrnwio. Mutltr't Atvh.. 1847; OC^t/: ,hihrbl>., IRfliJ, XIX., p, 
:il. — VOI.KHASX. W*- liiiihiMlf/nmnik. IMO. — Bkulin. Xnlrri. /.nnrtl, 1N.V). — Diiif. 
tiE«*. yf'f<rl hiiir, mV). v.. p. 521; '/Jxrht. f nH. MM, |S:Vi, IIL— Stil- 
LISG, JVn. Jn«.. IWI. U.. p. 17U.-ViK(.ilow. i>^M^« .I/rA.. IM-Sl, lU., p. 4>T. 
v., p. 3SI: U'tatih. A. mtc. P>tfh., IS.')4, I,, p. »3,— HeknakD. ComuLrttul. deUtmr.. 
€& &jC. 1852. in.; V. r. <W Vn^iti. d. «. XXXIV & LV . p. 228. IMW u. 3lSl. 
^KBR. rf*^ ccrfhH tt titnl. Jtjli't. Ktflit. cnjttU. in ntdilu mino rt iwirb., 18-53. ^LlEBKK- 
jlEisTBii. Df Jt'iTH ei'httmi'i. Gkycii. I*V(. — KfssMAfL u. Tbxnbk. ViUert. ab. 

L'rwj/rttti;/ u. M'rMfH tUr fnfUiic/it'trt. Zw^kungni M <frr I'frMutunff. toteU der FaU- 
»urM( "if/A., IHiT. — HRfciiR. IVrc/i. -IrcA., ISTi?, XII., p. J!l. — K 'UNkk. I'mtj. 

VJr»rA., IfttiO, ni.— Ai,. Schmidt, Art^i. f. Aunt. u. Phj/nuM , IHtil , \> ai^i; 18IW. p. 
4WTi. 5.iJ3 — V. RKrHMNiiifAl'tlR?!, Ih'e LtfinfJiffffHMc u. Otrt HfZifh.:iii» nimtrtjeiet^, 
XtHGQ; nrcA Arcfi.. XXVI., p. 172 — Gmi.tz, "iVrcA, ArrJ.., I8JH, XXLX,p. JlHI. 
O. Wkbkr. Uitndb. rf, iiWi. «. J7v«, ehir.. I»*fl4. I., p. 37— Stuickek, W'unt^r SiUyt- 
hrr., l»<». LI., p Ifi; LII.. p. 37D.— Kw. Hkhi.nu. Wienf^^r iyH2>i*ber.. Xov., ISO?; 
LVI.,p, UOI; LVI!.. p. 170.— <:oti-VHKiM, Vtrch. Arrh.. 18ti7. XL., p. 1; Cntert. 
»b. d. nritMtL Pnx'., IH72 — TltAiiitK, JM> Syu.pt. il. Krkft. d. lik^iir. u. t'treul / App.. 
18ri~ '' - '■ ' ■ T. y.i//.- »/. /'Ayj., 1H71. 

• ' later worlu on Tbyinology, and tfae pabUcationji of the Physiological 

In- . "■, IH(ifi-71.j 

IBiruitnws. ijuurtlrta tif tbr Cffefiviil CircnUttton. Loud., 1845. — Paqet, f^fcturn 
0n '^uftfirnt PnlJuJityif. Lond.. 1870. — Sasokuhdn's HnmilMMtk for (ha L'lbor'itorjf, 
PliJl.. li*7».— Daltos> and FiJMT's TroitUot on Uamim PAysMoinf.—V VLriAX, 
Lt^fMS 9Hi- VityiftrcU viift-ntot^tr, l874-5.^IiD.] 

LocAt DisTiTRitAX. C9 OP TUB cmcvLATiov eoncem the circulation of the 
blooO unj that of tlie lym[>h. In that which follows notice will Ije t^tken 
of some [i)ivsiologic-»l cou^iiJeiutiuti-s wlach liuve & general {uittioloc^cal in- 
terest. 

Th« MOTiOM or TtiE BLOOD 18 efTectfitl chiefly by the heart, its DtSTRiBU- 
Tios by the vosbi-'Ih. 

Hk-' iirakt iJ* tho most important Cictoi* of the bloo<l circulation. The 
foret* of Uie htmrt's itnpulso in luunintulH rijuals tli*; pit-*BUit! of a. column of 
toepcury I JO ram. high, and yet the physiological limits of this presstu-c allowB 
of a coaai<iorablo voiiatiou fiotn tbxs mean uuuiber. The pressure dopend* 



U6 



PRESSniE OF THE BLOOD. 



«nt upon the heart's itn[mls0 Is variable, ant] cUminiHlios with tlie inerefLsin^ 
distunec from the heart. A further increase of forci* for the blood is lierived 
from tho elastic and muitculur eteiUHUt« of the walhi of the arteries and 
veins. 

Tho ARTERIES are always over-tillod with blood. Tliny sock, in consc- 
qnence of tlieir small but very pcrfi'cl olastioity, to rid themMrlves of thi'ir 
eontimt-s by contrat.-tiuti, and ihim by thi* cuiitintiQtiH arrival of now blcxxl 
from tlie heart they cause th't n-*gular and uninterrnptcfd inovemfnt of the 
Atiid through the capillaries into thij veins. I1ie Kniortth muscles fnand id 
the walls of the arteries, especially numerous iit those of smaller size, are 
Ruscejitible to metrhanieal, electrical, Ihcrrnal, and clieiniesl iiritantB. Tlie 
funall arteries then'n|ion onti-act slowly, strongly, and coutinunu>>K% the 
contraetiou not eoutiiining far npward or downward, A Birmiger contrao- 
lion of the arteries is followed by an increase of the rehistaace of the cir- 
culation. In general, in the ind<>pendont power of the snialltu' urt«riea to 
cnntraet, may be observed a condition for the moderation or rognlation of 
the eiri^nlation. 

The ni/voni'RESSi;KE in an artery increases: \. With the tilling of the 
veaacis generally, aa with the quantity of blond, and with the narrowing of 
the chaitiiol. 2, With the frerjueney and foi-ce of the hearths eontrHctiuna. 
The mean blood-prejuinv in the largest arteries in man is not accurately 
known. In the art. brachialis it amounts to about 1 1.1 mm. ; in the aorta it 
bus Iwen estimated at 2A0 mm. ((piicksilver) ; in the smaller arteries it 
diminif^hes eorwtanlly from tbe left ventricle to the capillnri'^s. Tt is less 
in younger and weakly animals. In the pnlmomc it is much less than in 
the systemic circulation ; in the arts pulmotuilis it amounts to ]2-^> mm. 
TJie jtrHHAuro of the Idoitd is made to rise by muscular movemeut», and to 
sink by long fasting, Io^« of blo^jd, etc. 

Every part of an artery further presents tt pehiodical FLLCTI'atios in 
pressure : an elevatioti of piTSsiire corresponding to the heart's systole, and 
an ahatemi-nt of [ircHsure corresponding to the hearths diitstole — ihti so- 
calle<l pulse. This ttuetn.ition in prossuif is gn*atefit nearest the heart, 
least, or almost unuoticeable at tbe extremities of the arteries. Further, an 
elevation takes place during expiration ; a diminution during inspimtiou. 

Aoconling t-o QcracnE (R^irl. Idin, W»c!*T., 18(18, Xo. 34V tie arterial ware geo^r- 

atcd from tbu U-fl nidi: of the heart does not diHiLpficar hi ijduonillj- lut has bcca a»- 
Mimf^tl until now in tbe wiiftll arteries. On tb« contrary, there are pnrt» in which 
Tcry pftflo ninlflr imrmal, t.tiU mnrt- dintinctly under p.">tholof!ical coniliUoiw*, tho |iro- 
pa^tlon of the pnlne-wnvo can he observed to continue frt*>ni th-* hf^-^r* Into tbe 
capiUariCA. and even throufjh these into tho v<>m^ : these parts i\' ."'r -nails, 

the hand, the fore-arm. anH the foot. In the nnil the eapiilnrj i>v i>e«ii 

often even umlttr normiU outnlitioufi, ntUl hotter iu the oneemit;, in m-- ■■■ <> ;iEinii nf 
the band, mnxt diHtmcUy in ciwi-n of iiixulRRieiie^y of the aortic mlvp^. Mnnl pn»ha- 
h]y ahio the hrriin KXt-rr*t an iiotive and ititii^piMiduTit intlaenoe on ttie artorinl vrnlU in 
the motion of the blo'>fl throngh thf f'-ipinariL'ti. This determines fwrisljiltie. regular 
ooDtractioB of the artorias. (v. Uezuld, CaUn. nu» d. pht/s. Labor, ru tt'Unb.. 
18U7, 2. H: p. S47.) 

Tlie VEINS are filled In aiuneh Ivan degree than theni-teries. Tlie diiTerenco 
in the filling of buth kinds of vessels is tn be felt through the f^kin iu those 
\*hich lii! iifi»r the Hurfaiv*,,to bt- seen in tbe vessels which have bern laid 
bare, and is to bo perceived, PHpecially, from the various heights to which 
the b1ood-»ftn*am rises when spirting forth from vrtwela wliieb have been 
cut. The veins have « layer of circular inusfular fibiea, whieh is elmngly 
developed, esfM^tially in the lower extremities ; besidus, tliere exials a layer 



4 
I 



4 




nrcesmE rs TEtjre a:*d c.vprLT.ABrEi?. 



W 



of Inngitiuliiiiil Km»K)th nmttcle fihrcd, (•sp"ri!illv in \\\f> ndveiititia of ttie 
large vt'iim of tlw alxlomsn. Tlie netinii of flu-so nniwlm t'tr<*»'tti n sliortcn- 
ing of thi^ vcjisi'ls, tlifir rolastHtioii is folUiwi'd >iy fho vcaai-la' i-Innsintuiii. 
In the bruii) tin.' inuficular poftion of the vi^iiiH i«cxtroinolv little devi-Iopwl, 
or is entirely wanuuj». Th" I'^lasticity of ilu* walls (»f tjin voiiis it, imich 

Km tliiiii fliHt of tho aitL-rieJ! : t)m eliuttic t'lrtnents in thif voiiis ni'c alsn 
IMig4-(] pn'poiidcvtitiiigly in the lUructioii of the leui^th of tli? vesfirlft, so 
ttt esjiroiiilly the twiis of the int^?nial pnits of tliu IhxIv ate in their 
diameter iniiisunlly <Ii'|ifinh'nt on tin* varying [tn-ssui-e of their cotiUmts 
and of the |iartM snrioHndiu:( thorn. 

The BLoon-p«i:s8i KB in the veins is very fliictuuting, and ia mneh less 
than thnt ill the ni-ti-iit'«. In thr> veins near th«' hi^art it tinmunls tu only 
^ _ »y of the pif'H.MiM*'? of tht> ('oi-(v(i|iMn'1in^ rti"toi'i.-s. It UjiniuiKiji^s in the 
liin-t'tiun ttmurd the rijjht side of the heiii"t. In coiiiiinfaion rif iidJHCOut 
veins it imTeo*.'H in iboso whioli arc five. Huiiiti^ in»|iiratioii the blood* 
|ire**hiirr diininishpK in thv vcinn which an- near the ihornx, and inotvaaes 
dnrin^ cx|>in4tion. I)urin«( insjiiration the [n-efihuie in tiit; vi-iiw is, so to 
BjieAk, nogarive, i.c., it is loss thun that of (he ntinos|therc. 

The rATiLLAiiiBS, from one point of vit*w, ron^^i^t of closely united, tiat, 
nncleiited cells, somelinn'-s for the imtst purl spindli^slia|ied, Ktjnietiiueg 
polygonnJ (the so-cttlIi*d vessol-oells, r;n.lothelru). Between tht^sc cells are to 
be £rntnd oj^oniugs fstomala) of a |>erliaps rounded or more or less ellipticul 
onitinc, in vaiying niunbur, and in size prulMibly varying uifatly with tlie 
tUiim*'''<'r of the vessfl. According to ilic nther view ihe eiipilhiry nn'mhnme 
if Qot nniile up of colls, but is a soft pnttuplasmit? tuhe^ and probably 
permcahh' to nxl and colurloM bhiod-itni-pusrk's; it is further, :it least in 
vonni* veswls. forme<l out of cnnti-aotile Niibsluuce, so that it is ciitaMei of 
uctivi' cut] tractions. Concerning the ailvi-ntitin capillaris, so-culleil, vUle 
infm, 

BovKR. Aetit. Ai;Knn.\rit. EhERTU. nnri many others, anprort the first view, 

wltt«->i U >i:iJM:d tipmi tUu imti<;os funuc*) hy th<> aett"« of •tiU-cr on ileait tisaiiL-H, wbllo 

r vif wr wsB find aiiv(M'ftte«l by SrairKtlK, and is liawyl etpeeiaJIy iipiin (-xami- 

■I Itrmj; naiinals. Thu l:itt«r < U'lVn. nrnd Si/synfu't; IHIl")). nixl tfOLrnEW 

..-. .,;-,^y^ Arc^i , \., p. 4S), huv^ Hhown llint moderatt* irritation of thu living capil- 

luy ToveU oaose ajtcniotio^ loool dilatation and coutmotion. 

The blood pressxm' in the cnpillarics has no( l«-4-n UH-Jisurerl, but nnlyi-flti- 
inift4?d from (heir extent and the anionnt of their tiltratiuo. It varies with 
thn genenil blood-prossure, incrcasing with the dimiaution of resistance in 
the arteries, and with the increase of such resiMtanee in the veins. It 
chungr>N, sli^). with the change of resistance of the tissues which surronnd 
the cupillnriett. 

Tlie area of A crowMH^ctioa of the capillaries together atnouDts to more 
(hHii HOO limes that of (he noHa at ith origin; that of each vena cava is 
almost its large as that of the aorta. 

Aocordti)^ to (lM.Tx{ArrX f. d get. Pftjff., If7t, T., p. flS) the ■nrnicLfrM of the 
T«a»cJs (lerliaiM atrtx Ukfi tlini. of thn ghuid>L As tlio lattt^r. with the oo (>|K>rat ion of lh« 
nerres, takes up n Iluiil utrwim from onl. of the vicinity of tlie glands aiiH thtn moves il 

tntrt •'"■ ..-- -^'--.- .1 .,r ,1,. .,i.„,.i,,_ JO alwinay the epithelium of theTBwels potmcsa 

die i)to the iutvrior of the vessels. This character ia 

■HCf ai'l Binallest lymphnticd. the walb of which ooiuriaL 

OOljr at eiiitticUuiu. The forue with whlt^i the Hquid m'tve»> fmm the smallest liou- 
miHi'^lAr tcim^Im into tb<: larger. Is then the pressure of secretion, nn'lcr whirb the 
«pt •■■ - work. The smooth musolcs of the vtrsMls bebsTU liko those of the ox- 

rjt'-. of the glaodfl. 



148 



OOSTTECnOJfS BETWEEN ARTERIES AND VEIWS, 



In inony organs the arteries iire probubty aonnected with veins in a two- 
fuM nmntx'r: uno funii is by the I'tipillarj' cirttulalion, which is characterized 
OA tho gonoral, dw)!, ci- iiiterftliiia!, cbcniical or functional, uiitritire circu- 
latiou ; the olhur form is etTfcteJ by a, direct cuniiuuutL'utian of arterie^t aud 
veitis without ail iutermeiliatc Ciipillury HVHtetu: the tuJ-ca-Ued niL^fluiiiJad or 
dirt^ct, (htHvuti^H rirciilulimi. Thn KiiiallnHt artt^ri^s whk'h tiialcc up thU 
second form of cii-ciilutuiu are ubuiit 0.1 turn, thick, ajid i)i>!uu.'.s^ ort^uiic 
muacular filings; they nfi"- so contractile that complete obliterutiou of the 
vesseia c:m occur; they hnvu vasn-motor ut-rves. These truusitious occur 
bi'siiU'S in the coqiora cavernosn of the gcuilaU, the spleen, the placenta, 
in vnriouH purta of thi* »kin, apoueiin>He^, joiuU, uiucoua niombrHuesSi uiua- 
cles, bvaio, Inugs, in part also in glandular organs. 



< 



Thine relfttionit, impiirtimt in mnny points of view, with respect to the pAthotog^ 
of the local derangements of the eirculatioa, were alreu/ly knotro to LKFU^WKNtlOkK 
and H.VLi.EK. They were aecurnt^ly doBoribed by Dcuois (1^1, I. c p. 313). 
Paget {Load. Mat Oiu., ISTiOi. aui Wii. Jones. Aodoiduig to Tmrrrnw (.-IrcA., 
XII., p. SlO» a part of the h\cniA in iho ki.liioj-w can pmw ilirtxTtly fi-oin tin into 

the veiuB.wMleaiiotherp%rtof tllluwslhroiij^^h the>lalpi^hiAnb<«liefi. l!: 1'^;. 

}Vte>ur meii. Ztff., HUO, Xr, 40-12) avturnuti two fonns of cnpUIiiry n^--.'ii. mose 
which urv cumpjniLivuly thick otul in purl rL-L-iiu {.he uuarsu uf Lhu uri:;iiiiU cuDitaani 
uatioii ; niid lIlo»o which are uxoL>cdiii^Iy Ihiu, l»;tt<hin}: CTery tvU wilh liipiid. and 
fonning the nntritive network of Tessels which belongn to every or^n, There an 
Tcwwln iQ every org.io which restrain tho blood, and there btc thiwe which permit 
it to lloiT ou through. Ueaut; it ijaimot bo believed thnt all the bU>od irhieh tlows 
through an orgiui. c.y. thu kiducyM. the liver, oontributca to ttM maiutuunuuu ; thin is 
trae mure uftcn of only a p^rt of it, while another part ttowti through without «utf»r- 
ing any chnuge, and tnensly effects thu mi>c;hauical phcnnnicina of the cirentatinn. 
SCC<jrET(W(i/f. firfiiMfl.. XXVI- , p, H25, l!*iii .—iJt'uiu riretii. (Ifrictl. li-i/,* Un ««»- 
tirc» rt lUinn In Ute chn r/i-^m'/ii', ISi'i'J) found thitt wide commuoientlijux cxUted 
betweeu arteries and veins in dofiuitc li>cnlitica in the skin of the Wmlm and b«ad. 
In the np[)er extreinit'M'-H. c.;/.. then^ exiwU a dunlile circulation : the deep, nufcrittv*. 
tiuuHLa-iti au'.l almoML without variety, aitd the iiuperfiniil, which i* tnily derivative; 
both frtrint progr?** without iuu-rruiition, but thu latter vnries with tHe qnnntity of cir- 
oatating- lluid. also with the energy- and frcqueuoy of tho he irt boats, as vreli aa alio 
with Lheaetionof tbf v.iai-moujrmrrvesi. while the formr-r t-ulTetsouh- a sli^'ht change. 
In the hcv.l tho hlcKtd is carrind away ia lik« m.iii;it;r thrnutr'i the rtii,-i itrlrrut-rriutui, 
out of tht! arliiriikl uito thi' venous nystum when the- f(irin«r iu orer-flUiid, so that alw 
here the proper cap^lhiry oirculation oan n;o ou indepondeatly in a rvgul>-ir and cos* 
■tonl manner. Through the communicating ouumeoiu bntnohea of the vp'jtbalmte 
artery the blood U carried away from the iutomal arterien of the cranium ints the 
veivr fnftU't'^^ ft angidnre*, while the eye \s injected. The communicUl«n» of tho 
labial, oasal, polptibral and nuricular artoriex efftwt a reteaso of th- ' ' ' >Vflr-fill- 
iog of t.liH f.-vnial, inturnal m-ixillarj' and t:>iiiik:>ral. Direct coiiinri - acvou- 

pliiihcd in various waya. Uoiwalt aUo IloVKIl (i/Wvr'ii. <^. iN'o^ !■ ■■ U1»^ 

TOMHA {,Ai-cJi. f. Ver/tnt. u. *>/*A.. 1873, V., p. I) duiiie.i the no-called ■ ir- 

citlation in the akin : tbo soatt of thii lie in ibo^e part« of the head ai. ■ 'los 

where Lanokr hat dfimon-rtrated n very Might or no tension of thi> «1. id, 

luind) ; thorn pMnLt wheru thn moM of injection llow4 with gri>atAr Tr>T mi 

baa leas reslMtauoe to overcome, crdacldy very often with the po;nt.< m invgulnr 
dlTiall^t}'. Many others Hkewiau rugn.'tl thow a«.4Uinp:.iun« etill na ni)deinoiiictrat:-d. 

According to Uendplkisl-u i'J\iffef>l. it. AV. Vtr:, 1872, p. aiOt vos^wU ol Uxf^ 
calibre are foruiud in pulmonary empbyHema. betv/een the uxtcemlcica of thu artnHtM 
and (he beginning; of the veiua. 

The VKtiOiiiTV OP THE t«.ooD-RTRK.\M sliows cnnsijuit vaiintidiis ill tlw 
ai^vurtd kind:; of ve^iselM, which VHt-tatious are sliown partly by rneaos of 
Hpecinl apparutuiHfH (hjcuiodnHnotucter, etc), in [(art indirectly by obaonr- 
ing the circulation in the living aninml (meRenttiry, etc.). The rctdatAnwt* 
irhich iuQucncc thu rolocity of tho blood-atreuui, lie in friction. The 



TELOCITY OF TUE BLOOD. 



149 



velocity is grentest In tlie arteries (in the Crtroti*! of tlie dog about S'jO ram., 
in tli(! tneUliiriuil, Hl>oitt A't niia., in a s^contl), \i;sh in the vvius^ leitst ill 
the capillar its (iu the iTtiuu of man ftbout 0.7 nun. ; in t\w. tnil of th« Uul- 
jiok' alMmt U.G mm. in a scconii). In tlie Inttcr they hic moreover siihjecl. 
pi-ob&bly tu uiuuilbhl csneiitirLl uud ncciduutal variations. 

Aocordingto DooiEl, (,lrA, ifui tl. pftif*. Iiut. tu Letpci'j. IHOT, p. lllfl), the Telo- 
city of the blood iu the uarue nrcerinl linuich \» subject to grant aju! Kiifldcn change's, 
in sirite of the fuct that ttiu heart inipul-ie utiiI the menn tiUKid-pmftsnre raiiinin thu 
snmt*. D<w>[Kl. ilemoiiHtralod fiirtJiirr, tlint tlic velocity of th<) Ktrfjiinv which exUt 
in two aimrtlLiin'oinlv nhwrTt^tl .irtflriwi. vary .■vltOK'ilhpr iuflopooileally of uauh oilier, 
and aj> iudu]>i'iiil(;ntl.v aUo of the tiloo<.l-preiwuro. so thnt with t)io iiiinie blood-pres- 
feore tbit velocity la both chanuoU way IncrtKum in the cninR, or op)>oiiiLe direcliniis. 



Certain conditions from witliunt liave mi ijiilnt^nce npon the cireulutiun 
U) asks^y. or Co imjiixle it, cln«>lly \t\ thi-ir iiilliu'iieu ujmu llio veins. The 
«»urse uf the venous blomi is tht^refore very iri'i-guhir. 

Gkwity exwrti* an inegiihir inllneiice ujiuii thi; circulation, sometimea 
|irouii>tiiig it, somrtiniisi iin[i(!tl)iiy; it; Ihr furnuT upon descending, the 
latter upon ascending veins. In general, [pressiui-e acta utdavorably, by 
prevnntin:; the regular distribution rd" the biooii, and by pn.niot.ing its accn- 
mutation in isolated parU. By thin itf exjduined the iuliuL-uce uf the Biid* 
den cluttige from a horizontal loan upright posture, not mfrei]nently giving 
lise to fainting in amny healthy and strong pcrHoiiA, still more certainly tu 
the sick and convalescent. 

Th« etfeot of EiTBftNAi. PftEBSunB Upon the circulation ia im|H>rtant, since 
the vestw'lK, |>artly iu tlie interior of the hotly, jmrtly on the surface, and 
deep in thf* extnMnitiofl, are found continually under such pi-esaure. From 
thiu t\w arteriea s\ilfcr little; the capillarity s, mid espt-cially the veins, con- 
siderably, iivery pressure upon « vein is followed by an emptying of the 
bloo<l tfiward the ht^ari, beciiufve a turning tu one Hide in an npiioiiitt* direct 
tion ia in moat veins piwentoJ by the vaIv<;s, Such a pi-CKsurn, if inter- 
iaitt«ut, aa for example, during tlie musrular inovomiints o*' the extreiui- 
tii», nuty be ()f a-tt-dHtauc*- under certain ouiulitions »if iho nierhanical power 
of the heat-t. Hut a coa^^tant ptx-s^^ure, like that from bands, baudagea, 
exuJatiuuii and tumors, alfectH unfavorably the veanus cireiilat.inn — favor* 
ab[y> liowever, in the highest dcgret', when by pix-asure enlargement of the 
vcunels licconi<« reduced. If the prctssure itself is eln^tic, like that from 
inteattnal gimea in the abdomen, it does no harm ; fur just aa it hinders to 
tt certain extent the enti*auce uf the blood into the arteries, and through 
tljQ oufiilUiieu into th» vma jwrlti:, sa it promot<iH alao the ntream of tlie 
blood at thtj time in the vena porta; in the direction of the lie|mtie veins. 
The changing pressun- from th(» movement* of the diai>hrHgin inul from }&*■ 
doniitml pn-K8tir<.< <luriiig respiration aids tlui alidoniiual eiirnlutioii. A 
diminution of the pressure from withttut, as uceiirs in iIh! cliiiibiug uf high 
luonntiiiub, iu puncture of ufccitcN, of the eyeball, pwtiafly under the cup- 
piug-glaafl. eta, dilaten the veMels and fiivont a retanlntinn of the stream. 

CciLii eaiiitt-a a eoiitractioh, iik^t a dilatation of vefwels i>f every ewlilufl. 
even the aorta and tlie cava-. Cold cuuws, first of all, a vigorous coutnu.-- 
tion of the muscles of tlm vesHcU, which by excess of excitation is second- 
^ly foUnwed by relaxntion. Tiie>u^ etfects of cold and warmth are inde- 

ittdent of the VM-sii-iiintor nervea. 

Ex|»eriro«nt« of ifASTiNos, acuwaxx, o. WEuett. 

The larger lvmphati.'s have ussentinlly the ttjune structure as stnidl 



LVMPHATIO OIBCLLATIOS. 



veins; iin clastic intlma provide:! with »nilothuliDia, with numerous viU* 
a musculnr tuidUk' cout, uiiU nn udveiitilia. 
The LYMriiATUJ capillauies h.tvc uu cntlottit>Ii»I overiug, hut otherwi 




no elotueuts of a wall ; in general they rost^mblu the biwjd -capillaries. ^^ 
but the Willis aro more littUoatc (ou this ai;cDaut ^'isible for the mast |>uri^| 
only wiien udturally ur at-citiciall> iujectci, or aftur the culls of which tlu'ju^^ 
ate fomi'iJ are colored by giU'er), more numarou*, and much broader. Tb 
are arnuij;ed with respect to locality, eichot' aa uutworka, which uot infi 
qiiently a^coinpauy the bloodvessels; or, they are blind ducl», wluch iLft«r. 
ward uuius to form networks; or^ they form sh<*iLt)ia around the blo<>t. 
capilituncs^ i.$., tUoy lie between the capillary niciulfraiie proper and tli 
Do-callud Hilveiitit-ia, no ili:tt the blood-captllaritM arc 8t]|tarateJ froiu 
tinsue elemeata by a lymph -s|>ilcc. 

The (iRiaiN ur the lymi'Uatics is not cci'tjinly known. It is uifi 
probiibly in thu tio-ciilled I'L.V-'^UATk: l'.vnals — iipiioiis rd' the siunllLitit si. 
found in counecLive tiKHUO, without a M(H>cial meiubiiuif;, but prcjvideil wit^ 
flat uucluar no-called fiidothelitini, ustuilly tillcJ tmly with li<piifl. In tl i 
cei)ti-»l uervoiis-Kyittt'm the begiuulugs uf the lyuiphniic- vessels aiv pcriva-^ 
ciilar apa-'Lts, ir., bruiul L\itt>i(s cKith'.'d with endotlndinni (or pcritheUuia^ 
in tho axi.-t of whii;h arL- foutul the bhwdvouaola. Fu glands tlie ori^n — 
the lyuiphntic va->si)ls is id«>ntical with tiHsurua occurriug hetweuu tlu* blou< 
vcMstfla uud the ghinduliii- canaUciili, etc. 

.Sehol's UEMBIIANE8 Hre in open couaoction with the lymphatios. Tl: 
taketi place by mt^iinn of Kumll iMund hole)*, which in tht* living, and evf. 
iifti?r deulh i>;ceivy Hud convey into ihc lym|ihaties not only lluids, i-vuii 
such lis nrv not mirtcibh- with w»ter, as oil, but itLso scdirls, tm well tlioa^cf 
which Aix' chauguablo in form (tiiilk-i;lobuies uud blood-coi'puscles), as aim? 
those (luditi-iuk and uinnnlKir) which iu-e cliaug<<Utss. Nut imly Liquiilii 
[um noniinlly tlit-ou^lt tU-«? op^uitign, but h1s({ Ivuiph-corpuM'ten, which 
probibly hnve their orti^in even in the 8orou» mouibmucA. Tendons hni 
fa&clio beliave iu a stuiilar Uiuiuer. 

The iraportvit stutemeato ; iron abara oonoenihif; tba sonroa of cbe lymphaUcB 

(feiwratly. and tholr open co'inection with seri>U'» m jiijl>raiii^. wliicli lati *' . ■ miji 
ulrcivly uiA.'j|it!,'J. we ovpy to v. B x-kl.rstJrtAr-iKN". wUo dum JiMtratuiI .1 ' , b/ 

the silver lU'iLhiMl ftml liy exinjrim 'uLnU'Jx K.irlher itu|) irUaL n-sjunii , .iing 

tbetw relatiou*! ar«> funiinhel liv LriiWKi uud liU [>ii|>iU, Sell ^vmouKU-S 1:1 i>i:i., FitKV, 
CUKONMZUWttKV, A.KAXVtM*JKVV. Kll(:HfU. TuM.h\. ZawauvkiX, lilt*. 0L:r.»lAN?>6<>S, 
and uchtira. Consult olsi G jmiI. Jt-'r. i^n., l!<70, IX.. p. iVil Cjuuenuu|f the Ijrm- 
phatio vci*a?Ia of fascial, etc., ctntult. Gkxkkiicii xiid Lt^uwm 

The riwiMrelics of DvBK jwskv u;»ini thu plinira ul'*^ >fii n. pht/A. .-Ii.-' T ';iziff, 
J8flt*. |i. 40| Hre of spctujil practic-il iiit-HriwL Ctmcrninir tlii) i>ai)ii)l>i)£.i l» of 

■urouM mHmlir.iiie't. connuit Lw iiow^^kv. Are/i. f w/rM. u. /mlA llmUA.. • iki. o.^bw, 
and othcni. IftJu. 11.. p 71. WiNooaADJW. lb.. IS71. Hi. p. 1; IVkA. ArdL, 
LIV., \>. I-i. Kl.Kl.v and Bt-|{Do.\-.S.\>ub.Ksv*S. Mfil. Ctr'M. 1H7J, Xo 3-4. 

Aoconliiii; to Ut;i(l. {Lmtfjenrnft, a. t. w. 18t'J, {i. 4> tliu e|i;L:i>ittuia uf the Alreoli 
of bhfl lan^cn hiu Ihsh the Mgiiilicatitm of n coatinued brouohiiU e|>itlie]mni thou of a 
Ij^nphntic endothelium spread ont tin thn mnor siirfuoa of the alvirulur wull; bruu- 
cliial epithelium ixtad-is iutJ alveolar eudotbellum, junt as the ujiittii-liujn »l the P«llo- 
pitui tubtMt p.uu)C!i iiiiu tlie eudutbclUi.u of the peritoueuui. SlKOU^Kr \Mf<i (Urfti 
1870. No. •*»i( umk'-j* the ly.upimtii; plE^xu."* Jn tlio w*IU of tin; alsticili coattiiiiuiuitt^ by 
luaaiu of &\u: opmin^^ with thr luuieu u( the nivcLilL ThcrLfon: Uik euvitiHit uf th« ' 
ulve>>U arn wM'; Ir op^'"*'^"" fl>l<)d witb nir. The cautiil jrilile ipi;inttty of curbouie 
auiil iu lympiiaue gat>M ^^O-MJ \nit uunt. : HASCMKKsrK.s'j mty lor th« iuom part W 
donvod rlir^Mjtly froio iiupir«d atmoopborio oJr, aud its quiok ttaustoruutiuu Into I 
ctirlKinic Kcid. I 

Aocorliiig to ScinvALBE i.Jfiwt Gtrhi.. ISOO, No. 30; Ai'eh, f. m'kr. AtMt , 1^70, 
Tl., p. Ij. the amchiioideau spnoe of the brain and kiiiuhl uoi^l is a l^viuph-vpaoo. 



XTMPHATIO OnWFlATKMT. 

rhich commtmicatos with the Irmphatio-Teaiels and giimdii of the neck throaj^h the 
JQtpilnc forniQ<:u, as well &» with Uhv Ijinph-conolb of the three higher orgnxm of sense. 
(It haa uo cuituootton with iho )teriva»utilur ti|>iieea of ilia, nor with cbu ],viii|ihaliu» 
of the pin iiiiitor. ) Id ttie eye. f.ff. , tbero arc fuuiiil two groupa of Ijrtiiphu'uicM ; nt 
thmn tbe iKWteriof aru to u» of Hpt^ciat intet»*t To thin (rrtni|» Ijeloug tin; iwriviwciiIiLr 
spaoeB of ihti retiim, tbu per.cauitHd.)! >ipuufl tuiJ itn elF^ruut uiiiola, ami the lymph- 
space l.vtn^ l«twn.:*n thi^ iiiuit'iaJ luiJ **xtt^rual aheathK of the optic Durve, which ojx'n* 
directly into t^e axnchnoitlean Ajincn oE chu brain. (The anterior lymph •pamagos of the 
eye do noc conioianicnte w>th ihu posterior. Iktth chambciei of tbe eye form a tytsUsm 
of carrcnu tvhich haft its offcreot oimalH at thi> conical furrow; thn lym])hatio vnawls 
of the uuiijtiuuLlva form u tti'.ix)ml Myatbui, Lhu plexn8 of Kinull ubauiiulM uf the cumiHl 
funu a liiinl. > 

According Uy b'MlM ( Wurtb. Dm.^ 1S9S), there taken place, nnilvr wrtain coiidi- 
tioDd. 'A ie»)r|>tiuu of liuuly sUBjiended fat. or chmnhar, from out of the uavitica of 
the joint*, which, thcrufun:. LLkt.'wiHO puiuCK to an open uoinmumcatiou hclwvcn thMO 
cavities aiiJ the vuoulai !«yMU:iiL. U. { Vireh. Afeh,, IFMU, XLVII. , p. 21H), after 
tn>atuiunt of Hyritmul mtinibrnrieK with Milvi'.r, haw an o\wu. connection of the liuoitw 
of the bloodvobteht nith the plufimntic uanaLi. 

The flow of lymph out of its vi>.Kse1a into the veins takes place very 
filowly Mnd umler bligtit prossino. Tho forces 0[jorative here dxiYar ft-oni 
tL(t«c which chiody eiruct the Ui^tcbAigu of the lycupli : they are as|tinilJoii 
of thtj thorax and ooDtnictiou of the miucleit t»un-oiiuiliug tht.' lymphatics. 

IIEZJ.KK (^t/. Vtrihi., 1869, Sc. JVi) foniid in the expoecd nieaiiiterj- of yoang- 
^inoa-pi^ a peanliar rhythmical movement, which IwarH a type indepoJident of all 
other rliythinicnl inovemeots of the (>r)foni9m ireapiration, pul>»c). 

Thi! cuui*; "f tho diaehutgc of lymph is tho diff«T?ncc' iKJtweeu the prcMuru in the 
capilluric^ and thiit in the lymph- fpacca. liy lig^tturL- of uU but one* of the lymphatics 
of the (iixtiole, which uta wiiKy of liccoMit Ijenr^uth, iiuil of \.\w- Hpi<rwatic urtvi-y, mora 
lyiiiph in tli»rbiirg-Hd in thn mmjcrnt^ ootitractinn nf the pnmpitiifnrm plexus thnn whun 
thff vf-nom sttt^am continaes nnobstmctoj. Should the artoriiU prcMiire be rednt-id to 
a micimam. no lymph at nil would. lu a rule, be dii*eharj,'ed. Acc»irIinK to Ll'Iiwih, 
the fftAchc alM) hi a deud aoimul abHorh to their fnlle»tt <?xteut Ii()nidN which biivn been 
injected in ^ucrh manner n» to ]iio«]ace rhythmic UMittion aiid relaxation; the oolored 
matter injt.'on.'d tb doinuiwtrabk- in the thurucic duct Duriinf muwinlnr ruHivity in 
the livini,'. where a like ultcruatiou between teusii^u and reluxattouof tbe fbHcitt* and 
a|>oueuii>«(.-s tokva plauu, thumj uicmbroucti and tbuir lymphatics act Like iiuukiug- 
pomps. 

The (iiTASTiTY OF BLOOD in general is considered in Piirt IV. The 
quantity in 8inglc oi^us varif& gircatly under physiulo^cal nud puthologiciU 
conditions. 

< )r' thr- KLEMTWTS OF THE DLOOD, the blood-coiTmaclcs, especially tho white, 
aud tibriu have a i>roniin4fiit ]tHtliMlog)cal higuiHcunco. 

During thu flow of the hlood through thu cupillariea, only ilie fluid el(s 
mmitci piifts nrdnterruptedly otit of tln^ latter into tlif> tiKKuea, anti out of 
tliRsr, in a moiltfiud trondition, hack ajL,'ni[i lut*^ tin; vess^-k ; but Ui<i»t pniha- 
bly red aud cspttcially white globules iiorinally lenvt.' tho cajiilliirii'M to reacli 
tJ)« adjm'Hnt Ivuplmtic!! or tis^uo. This trausiiiigruliuu t:iki*H [ilace only 
whvrc tilt* blood-fiirreut i« tdiiggish. Jt takea jdace witluuit injury to the 
vftsstds, in a matiinr as ynt unknown. The wanrlrring nul bluod-globuliis 
in^istly n^tuD return into tho ciivulation through the lyiiiphatlcs, Tliu white 
glubnies which have wandered out form, all or the greater part of theui, in 
_tbp various tiaaiiea ih« ao-ealled movable or wan'Jei-iug connective tiKHue 
[)ipuh4ti-s, tiuicouA corpHBclea, salivary coriiusch'S, tbt- corpuAclett of tho 
Brous c^tvities, perhaps also the rouad cor[iuscli?s known in the gray and 
whit** mibstauce of the amirul nervous oi*gaim. They prulwibly i^-turu again 
into the blood in tho mimu way as thu red globnlt^a. (Jonac<|Ueiitly the fluid 
as well uit the corpuscular eteuteuta of the blood have a double way of re- 



J 53 



MOVEltllNTS OF WHITE OLOSULES. 



turn from the cai>ilhrl(?s to the heart : on tho one band, bj the veins; on 
tlie olher, bj tlit* lyui|ihiLtic8. 

ComqU Strickrk, CoiiNticiii, HcitixQ (I 0.), Hknle and HnitKRi. (Z./. raL 
Mf't.. \i*r,s. XXXIV.. p. -13). 

The CAtL^e nf the tntiinmig-ration cf tbe white (globules liea. according to ConxUKiM. 
in tbeir active moUiliiy , nocordinff to Scnm.AnBW&KT (Arch. /. rf. f?«. /**>*.. ItWtS. 
1,1. ill i)hjr-k-*U furoett. Aoconiius to Heuino i Wirn. i^iUti/igahrr., LVl., |>, 'iUl. and 
LVII,, !>. l~i>i, the honKi^cueuuH mtitwt. with trhicb tli« rud (ftohitlef uf the Mood 
(laiiimi-d up iu tho vuiuk-U n)i|)t-nr tu be bU'Ti<1i>d. nct«, o])]iq<iite tho woJU of the veiuwb, 
liko n liinid nolloid mitust-iittcu. If the prc-yiiire bt> MiflfioientlT pp>lon;rMl. it exudes ia 
iM}lau>i) (iroiM throujfh the wollit of the vcjwt-'ls and »!owly oxtmid" ioW ihe aurronnd- 
in^ 3tmctiirf))i, wbcrcbv. if the exti-ftvivmtiou (rxluiidM into a l^'mpb xpace, the indifi- 
duol bloc^l-^'lolmltis may ftj^aiit imoumti ttii;ir old fonn. 

Direct obavrvatiunM tjiuw tbut the white globoluit of the blood cmn [trobubly enicr 
ognin into llie lULme ubniiiitil hy the naxae wny through which thej tfft. it. Ri:rK- 
l.lNiniAUKKN [StrirJc^r Iliih.. p. 21il; not only uaw tho colorlf^sa wlU \tam oat of thu 
capillftries, but also mifrratory corpTi.vles iif the ooiincctive tiwiuo enter into them. 
SwioTTt [lii^rt. facd. Clrthl, ]S"fJ, Xiw III and 1 1) wtw tlw Bamo. Ho ha* beiida ■ 
dtitm>ii!(lnitfd ex iK^riinoii tally ou tbt; wt^b i)t the fnig, thut pi^inuul celht suud theii 
prooesiMH into the Ttfiwelg through their wnll, oo ihnt they really migrate wi a whole 
or by pioi'e« Into the btoodrewels. and ikrc ourriod uway by the blood-cnrrent. ThU 
occunt normally, tu well as Aft«r the uinployinuiit of raeana to ojcoite iDfluiiinLa.tion, 
iu thtt ottpiUiirieii as weii as iu the small, pLThapa aliio large Tciiw. 



Under varioiin coiuUtious which always cause a congestive hi.'penumiii, 
the number of niigmtiiig white globuk-a iiictvuHca very considenihly, and 
given new U\ Huppvinition. Pfs-t'ORi'l.'8<JLES» ao-L-alli'd, are rutt the tiacATtR 

FART MMlKATSn WHITE nLOBULCS. .Sue InKLAUMATION. 

Thfi white jiiobiiles, which have tho profiertiea kuowTi in th« dciul iitat«*, 
allow, when ftlive, n pecnliaiity, which explainn the foregoing facta, and 
Wsidcs is of im|>oi'tjiiice foi* jihysiology and jiathulogy ; tli«y are con- 
tr«etih;. 

Tnr. iroSTiiAiTiLiTY of the whit« gluhuUis, and of tho corjtUBcleR identical 
with tliiTn, w Klutwn iu tin* examination of Hvuig anininls (fnot-wi>b and 
mcsentury ^^ the frog, corlaui iniininiiiU), of frcnlily di-<Mtectt;d aniuuil ytkxM 
(winuurtivf tliwiie, cuinen), of fiT.nh ylobitlns in jh-ojrt iu(>ntitrua (natural 
liiiiiid tmnsudutions, weak ftohitionii uf Ku;;:ir and common ibtlt, t^tc), and 
wlieu puKuible, during exaniiiiiitiou upuu the warm »tage uf lluidtt contAiitiiig 
BUfh boda-a (bl«i(ni, rinicua, saliva, ptis). Hie curimscU's du not then a|>iiear 
rouitd, hut jircaent jioints of varioiiK Wngtlis, numbers mid forms. Each 
corimacle changes its form continuHlly, trending «'iu miii^kly fiiin fil.nnentf^ius 
|ir(io[>sijt.'H, singly or in gronpH, whleh jirocfSKes thicken ul iheir btisu and 
uoiwist of a [KU't of the Muhhtunce of tlin wll-boily. They again ivtract and 
diaappi^r withoitt leaving luiy tracers uf thi:ir tixistence lii:liiiid. Sumr^ttiues 
these pi-oceRfM>!t apjM^ar on the whole ct renin fnrcnce of the pns-curpusrle, 
from t-cn to twunty in nnmln'r, enmetimcs tufts of from three to kix a]>]»ear 
in one or more [mints of the |>eriphery. The Hiiiglt* HhootR of the cor|)iiacles 
may brnneh again and nnite with one lUiother in twistfd forniR, and then 
ilow together into ono bi-oad maas. The corpUKcles cuntniu nuclei, whieh 
become visible oiUy by means cf reagents. They also contain molurular fat 
nn<L pigtiieiit, which (change their locality in tJie cells with their motion ^so- 
called MOLKccLAH Morn^vs), tliefle moiious being most marked whoro pro 
ceHHt-ft are given out from the cells. 

Thit corpuscles exhibit these changes of form as well in liquid conneotivo 
Bubxtances (humor aipums, serous membranea) as in aoUd tii^nes (cornea, 
connective tUsuea chiefly), and consequently they wander iu them, for the 



I 

a 




MOVEStEST3 OF WniTB (X)BPIT8CLES, 



153 



most pai-t in very circuitous routes. Migrutiun is accomplished in tho 
following iitatmer: tlis cell-iiiai« slioola tn:i into procetuKfs, then (lie ronml 
end oppoHito t-o tli^ pixH-esH ailvmici'S with it in Hn(!, itnil tht-n, by a farther 
eloiigHtion of t)i» butly uf Uif.' cell, it ntovtm on still fartLor. TIiih migration 
takes ploce, as alrtwly said, not merely through open spaces or cavitiea of 
the connective tiadUOt ^^i^ u'so thiougli lh<! walls of the capillarLeR ami 
Kiuull veiiis. 



Cootmctility of animal coHd was observed in tbc white [flobtiIcK of tiifflict and 
lower ajiimalH, by U'll. JiiN[-:<(, Davaink, ICoitiN, KcKKll, iJKiiKkK' UN. Hai:ckcl ; 
hi lymph-onrpUMcIed. ixirimsL'lt-H of tli« niiken, TniiooUK corpufi';l«B, m Kimihir cbUm in 
the t nutmitlation tit (»f>roiis mrmbranen. i>tc.. by Bi'isK and IlL'Xl.KV, Lli-:iitnKriTN, 
Tiwiinw, (iKCki.lKDMAi'KKN.OKHl., C<iHNitKiM. (-Ic. ; in thfi ficfi-mcnwxl plohulcn of 
the trog'f, ovnm, by Sthmkhk ; in pigment onlls. by IIitCrKE, \■!l«^Iow, lx)Tir. 
MKTEn, Wrrricil, Rmcn ; m plgrtnuub-oeJIii nf cnlloid tjiwuc nf InwRr animalii, by 
Hlxi.KY ami Kmi.ijrf.k ; iii tiif f;KllM of BiiL-liouclrunia. by Vincrow ; iii (riant ceUa, 
by LANoiFAts. etc. But HwKt.ixnnArsEN ftrst liemotwtnited ibbriuular occur- 
tence and patLoloj^lcal signiiieaiice of that peculiarity, ettpcciaJly in pii.x-<;uipiiHclet>. 

LtkbrbkCuK it'rfHrr Bttett/yn'jsir^cftCHi'inf/eit dtr /CrUf/i, ISTO) hcims esfn-ciolly 
that tuolotiiiliir movKmcnU within Uto body nf tUc- cbU, tlm furniatinn uf vacnolcs in 
the Mime pUcc, aa wall a^ ccrtAin phiirioiii«nA of elnsttcity. wlii<:h bavo Wf.n re^anlud 
u phenomena of conlractinn, nnil tho tnic niov«nionta of the borly of the vr-11, are 
iuitepctHlent of one another. Tho prop«:r contmttik moTemcntu of csIIh. wbureby 
they change thuir external form, arc indopcitdeiit uf the niovcnient« of L-nuuracLilo 
Hib«tancp«. which relate to the :ipp«aranc<> ujiil di>appeanuic^ of the \-auaDlea 

Ri'jTU { VireM. Arch., XXXVI., p 145) ninkeM prumiutuit the great liannuny which 
jVcvaiU with rmpeot to the chemical ntactuHi of tlniil-t or ti.'«H[iBR in whieh the ph^ 
Dontrna of protoplasmic moticm are obBorvcd. Thiti renctiou is alnnist unlvi*nuilly 
feebly alkaline. Ri-ldom neutral, never aci<I. Thin ohcmicol coudition \» probably 
nacewaiy to hold in Molutiou the albumen iKfiiMi's myoiiiu), which ui the baab o{ 
Uw plieDomena nf life. 

Frvm obflermtions directly mnde by ScnirLTZR (.Irc/i. /. mirr. Anitr.. T.. p. 1) and 
othcTV, an elevation uf U-iupemture wait found to acccL-rutc the protopliusmic niove- 
ucutJt of white bluod-curpuKcU'K and muki: them more active. According lo ScimsK 
( HV^*. iifivf. SitziirtgMhtr, IWHI, LX . p. 'J") thu bluod-cDrpuaclcs uf c<ild-lil(K«lcd 
anunaln pt,ill move at — ■i'*, thi«ep of warm blooded aninialH at — 3*^ H, The bltjotl- 
oorposclca of bstmchiana may 1)e fror^n for bourd Kt n time, and Btill move when 
warmed tfi 40*^ C ; in those of rabbttfi thin wa» the orvoe only when tht^y hod been 
fioEtsn for 10-1.5 minutes Soinetimeti the white cnrpu»c)cH of niaii, withont f>peciBl 
pr«|inratinn, exhibit movements 10, 30 hoiirti and lunger a[t«i* dcaih. 

Acconling to BlSE {Arth. f. mier. Aunt., III., p, ywii quiiiia iicLm very deleterioualy 
on tb*» movpmentf of protopliwm, espeeially of the whit<> {jlobnlex. 

Afxjoniiny tn SrilAKKKNUKaiCH (Sfetl. f rnlr., IKd';. Nr, 'i'i\ tho mifrralioi] of white 
blood -j^lobule* into the niewmtcTy of the frog' becomes vonr icHi]^] Scant, if a xolntion 
of quiiiia (certainly in ip^At, unuAual doKs in tbcraiieuiOi^) be- painted on, or injected 
Buder the nkiu. 

By the employment of the molut diamher and warm object- plate, ama-hold move- 
mentA and iirwc8«c(t of division in red g-Iobul»R wrrc fir»t ohnrrvcd by Prkver 
f \'irc/i. Arci. \*ilj4. XXX-, p. -I'^'Ji. then by Itui.LKi*, Ki.KDf*, BeaI-K. ftiid IIastIas ; 
FniRDn^iin (M., XLI.. p. 30i\ ub(«crved them in hUKxly urine without these helt>s 
< prot^bly in couM.'tjuttnoc of tlie uigrcdicutx of tlio urine). Kb ohKcrvcd thu Nime 
idvo In two i-a8tiH uf Wucocythiemia; IlKl.l.nn { Uutfrn., \\ 20) UkcwiHu, ami in u caxo 
of pnt-umonia ; M08LKR in leucocythaimia. Many other obMrverB, however, deny the 
cODtroctiUty of tho t«d-oorT>tti*e1es. 

Colorless cokpdbcles, by th«ir coiitntcLility, Are alito able to take vv 
Mul TKANPpoRT FORRioN suBSTASrKB (carminc, Cinnabar, milk-globiilcs, t«d 
hlood-oorjiuflclep, dui»t of evei'V kiml, etc.). 

Injection of coloring mattere, ehpecinlly crinnaljar, into the vcin.s. followed 
nt vjtnt'iiig intf<rvals nftt^r by examination of iho tissnoa and orpiua of the body, 
pruuiiacA nianifuKI re.siili.s bearing on physiologiral ninl pmhological oon<li- 
tioTuu A very snialt portion of the coloring mutter ^rubuLly pauwfa uut uf the 



PROPKRTIK^ OF WHITE 00RPU80LES. 

Cfti>ill»nVj{ Trw. or oxtra-cclltilar, but the grtMLest jihii of it^ &ft«r lieiiig iHkeii 
iiji by thtj whit* bloml cor}iiiscli48, paa»rf)S out in titt -cellular. The jiaiiwige, 
jihyBiologicalh* iiupoi-taut, nf white bloncI-coq^uscLes into tiur aecretioiis i^.t/, 
aulini, nnit^us, iiiiik, Ihls not yt^t ht>eii dftiionHti'atml. Iiijectiuii of ooluinng 
luattt'i's liavu tit^uii fMU'loriiii'tl liv (milioluj^iitU H<ipt>L-iiilly to leum tliu fuU^ of 
wliite blood- cor |jiiKi:K^» tilled witli gruiiulos of coloiing umttcr, und which 
havt* wiuidfii-ed out of tJio ^'Hiisels. \(nrty believe tbo cN>iiclu.sion authorized, 
that evHry yomi^' ti»«n<^oIuiiieiit (upithelial cell, cylindrical cell, niu^lo cell, 
etc.) wliicii cuiitaitis juirh nioleculuH after injection of cglorin;^ tnatU*r. in a 
-whiio blood •coq>uscle in tha ])roc>e88 of niE<taraor|>hosis into an opilhelial 
coll, vtc-. Tliiit Hi not juHlitied, siiicu niuleoulL'd may pf*notratt) into very sufl 
yotinj^ tissuv-nK-iunits after thuy have becoaiu iutnt-uellular, or if tbey were 
until theu cxlrtt-ccUular. 

The varioua tissues and tiasue-olemonu harbor the coloring matter in 
vwriuUH way8 ; muuetiuiL's Lu great cjuantity, sometimes in vury small quan- 
tity, and HoiiitttiiutM not at all. Experimentation couoemiog tbeae uattere | 
.allow iu many poiuttt no iinpurtunt dt(ri.-ri-nct»t. 



That the< white glohulvH abnorVi foreign sab^^tanoe-i into their interior was Drst matla 
known by II\ii:cKK:r.. tbun hy CouNUKtu, Ui:ci:LtxouACtiex. etc ; the name, with 
nwpcet to the red globulus, vaa duiunuxtrati-i] b^ PnGVEn anil LlOiERKrilN. 

I»ON'pirK ( VVivA. Arch,. IHtUI. XLVm., jv Ij, tlno Hopfman ami LanokriuVS 
(76,. XLVIII., 80t). Juuuil thn following with renpeot to the contionnncc of coloring 
tnntt«r ( mostly ctniutluir. Mldom anilini! blue and ultramarine i after itn introdnctioc 
into the voin-* of frog*, rabbiti. guiin:-<»-pi|,'s. and doffs. After a few hours (4-C| the 
cclorinj^ inntttir waa almost nlt^igcthcr t^iken up by the white ulobuK 8. Souiuwhal 
lem ijidiJcIj' (t(i '^ hoiim) a hiiuiII ijiiantil^- rtf if. (lis-tjipttarwl fro:ii the ei rculaliaii ; 
wharuiui a grvat ijiiniitity mriiainHd in il after many wenlta. Oiimahar. mnlu^ed in 
\BTgo cell!* iMirtly oouu|ti(xl bv blood -^obulos, wu found iu the blood of thu splenic 
Teina after 14'^ dayti. The spleen, lircr. and marrow of boncn coDtaiaed cinnabar In 
the intravascular lisBUcs at uctirly the (»ame tiino and in e<iual dqmjeiiL 

Tk<: s]>U-t:u auU tKmiiruurruw each tiuic? JiicIudiKl dunalKU* in tbv clcmeuta of thur 
peculiar tuwiu'. Thu latltT thiiwoi] U witliin iUt mriniui fonna of ce'U, irith the 
exception of the jfiant-cellH and saiall round cells No colorio^ luatlcr wa*i to b« 
loaiid in thti Malpighian budie» of the spb-en, nor in the BUiifiorting co«acctive-tiBM,e 
network of t>io ej>lecn and lymphatio glaudt. Iu the liver, cinnabar vaa the fra- 
quent cause of capitlary ciabolisiiiii. lUi aeenmulatiou in the C3pUlurtt.-« fuUuwa Tftry 
qnickly. and it is contained within the white globiiIe« of thH bloo«l. Fur trom 4 to 
U dayn it id quite uniformly di-->tnhuteil in the acini ; later, in guinen-ja^ itii acuu- 
mulaliim i>ri'd<imiuatL'»i in their centnil; in nibliit«. in their pt^ripberic half. The 
hepatic cellR never contain them. Aeeordinff to PoNriCK. cell* containinif cinnabar 
are fuuad only outi>ide of the ve«>telM in the lyiuph-apacCD in the u*'ighhorhood of tha 
oapillariea, CiiK<ri)ig matter ia alwnyn finind for a certain len)j^h of limt; in the veawla 
of miiHt uf^na, and then at the eariitut nunueat after the twvnty-hrnt dar they a|^n 
become extnvaHrjtUar in the tift^ne. and Inde*^. aa it sceinit, alw.ijx in the fine oon- 
nective-tissuQ corpuAcle.i; as iu the ooraea. conjuuctira. (ris. cicatrioes, suboaianeou 
tiasuoit. The spiuad of ^ranuleM of cinnabar in the individual otji^ans i» very iuoon> 
•tiuifc. They arc aftt.-n fduud iu the ton]fuo (uapeuially itn mu(v>UM raerabnuici, in the 
salivary }<;1aTtdi4 and pancnias ; in th« raunoan o<jat, i^tildiim the aitbniuoouM, of the 
intesrinnl tract, alrao«t never in itn mnacobir and fsexon" r;rtiit« On the tweaty-flnit 
day the kidneys coot^in cinnabar, not infrequently dtetributcl over tlie whole oi^an 
with great uniformity, in the oorpuaelca ot the interstitial tia-^uo. They arv hkewiae 
to be fuuud in the counective-liisnL' corpmicleaoF the supra-rvual glands and t«*KtiulCii. 
(In Mix impregnated animal noither the embryo nor plaoenta coutatut*d cinuabaLrj It 
wa« mnr4< often found in the niucouH mpmbrane of thit iarynx and trachea. The | 
Innga were always very rich in it, tm nocoant of numerous capillary eitilK»li. Bone 
and cartilage -corpnsclcfi never contaiticd cinnabar ; it woa more ofton found in ihe 
synovial membranes. Haversian canals and inttinnutfcular ttntae. The tirain and 
spinal nord even were very deHtltate of it. The lyaiphatic ^rlauds of the wound of ' 
opemtiun. of the uieaentery. and of the liver contain ciouutMir very kimui after the 
iDJedioQ ; partly free in the lympb-Biaui, partly in the round cells, or La the IftUec 



romtATIOK AJTD COACrLATIOy OF FIBBCr. 



155 



"oSy. Btr^r in the rwticnlum. CiniiRbar wttw found onlj: vt-ry late in the remaitiing 
lyiiil^ntic ^InntU, niiij iiide^J only io the- Iyiii|*li-8mti8 anil dticbi. Cinnnbar honnuver 
ilpuiuu6trat:-<l in canihi^, t>ouc, ouil cjii thulium, only in amull i]naiititT in the 
nervi'iw Ajiittiu 

'Rki'I/. I U'ltn. iiiiiJ. iH.zjt'trr.. 1HJ,H. LVU.. ji 8j faw jrnumles of coloring inattar, 
after injei-t:<>n>i <rf c.nnitlur ji)t4> the lilood. in thone elt-inonu* bIho, which hud never 
bwu conULnttd withiu the; ve-iwisr-atf tu the epitheliitt rdlln ot oil the innutftie mum- 
bruie«; likewise in ibu ciiittlu;;iM, in Ibc ccIih ax u-ull as in thn Uit«[cenular t>ub- 
stftUfe (uIku Ucroit luiU Ulitzmanni. Tbv qtuitilitjr uf culoriu^ matter «raf> hi much 
irccntex, if iullaiiiui ilJuM atTixTt*^ the locJiUvs iu iiiiPRtioti. In lui iiuprL-)i;uutu(l 
mhhit, oihiriiiif traatt<.-r ivil** found not only in the uu:ru» aud plnci-nta, hat uhMi iu 
thu blood of the (u.>tUA. f^itpoi'iJilly abundant in tho oa|itllaricK of thv pin inut<'r ' Thu 
pftCMinoe of c«lU ccmtftinini; cohnio); niattt^r in n mut» of inllammatory origin dues 
not yot decide the«o c«lht lo b6 miifrntcd white blood-celU withont further iuveeti- 
gnciou. 

Colored {jarticlua, eKpooinll}' of oool-dust, am ver/ conimoul/ foiuid within the 
tnurtxio i^dqiuMolt^K of the upjx^r purt of the rtxptnitor)' \\i\uti. How Uhh and uthur 
iluat pfnelrat-es into the dcejwr lur pawuigps. Iuti^k etc, , i» not yet at*:iiriit«(,v kmiwa. 
White blood ylobulrai at> well iw wnnderiug eclln iiuroctimea also Uiko up red ttnd 
white blood -ijlobuh:^ Olid v.\ci\ opnJit:-ltiU ccibi, and movft aWKjr with them. Tbo 
former takt;B plact- ttoiuuunii:a in the s^inio in»uni:r ux with ooloiiug matters, and the 
red globules thereby are usually divideil into many ttinidler piur(4i; but ifometimcti the 
wnnderio^ ci?U aucTDUJudii a muoh larger cell. lUtogether or by luaviug a part free. 
(UuKrMAN, Virck, Artiu, LL, p. a7a.) 



The C'AL'SES OF 8BCKET10S OK FIBKIN OB OF ITS FORMATION are of 

iiiiportanct*, witli i-eRpL'ct to the tht^uies uf tli roiabosis, tlropity, aud iiitlimi* 
lantivn. 

Fibriji ia fonneil by chemical coiiihiuatioi) of a FiBRtsoPLASTlc 8ubi%tatice 

I belonging to the cant«iiU of ct^lU, with a riBarsooENlu 8\ibst«iice [wnuliar 

UJq the ibtcrct-'Uuhir tiuidx. Thu libriiHi|ilHslic ttubstuiicti (pumglobulin) mny 

|Bdi&cluirgcd in u boHtl form frout tho lluidh cuutaining it, not howcveL* 

™ « pni-« state, but mixfd with other bodies. Ked corjtuMclej* «Hi»*t.'ialiy 

ore fibi-iuofiloHtic. ChyUt, lyuiph, [>us, curncul tisHtus tlin iiuibilicul vtiKHcls, 

the leuf), ituhts] almost all i-ellulnr fleiuPiitH, vtw (ibrtiin)]IuMttc ; fiually, 

flitidB iu which tho c('ll-cuiitcuts an' trausforniL-d, aa blood- sc-runi, the 

htiniorti of the eyo, fialiva, ayuovia. The white of the t-^g, tondou and 

cartihi^> ai-H not iibriuo(-ihi»tic. Fibriuogoim are not only thoHu cougiiUtixig 

tilioutHtieouHly, but aJumet all kci'oiih Huids M'lnch by thu addition of a 

fibriuoidustic hulMtnuev art? CTwigv dated. The whittr of the egg, th«' btiuiorH 

of the uy*-, noniial synovia, havn uo fibriuog«:umo pi-ojjBrLy. Fibiiu in 

ftycrt-twl under noiiiiul conditions, if the tlui<Is, p-.y. th« Mood-iddBnia, 

which contain lM)lh gt-nyratorrt of tibiin, have l>eeu witlidrawn fi-om tho 

" ;iug biidy. In the l>ndy Bvon, coagnlalion of tho blood is pi-uventud, 

ugli the ijiflueuct) of the walls of veaselci. 



9lt(VKP. hati drimonstrated by ntimproux flxperimentx, that tho wall of the tmnIs 
indeed thfi inner membrane of the tilnixlvoaBelB, an well as of thf tymphatios, 
aeroUK mcmbraaaa. prornut coagulation of tho blood tn livinir vetaela. He 

Died blood ni a tompcmturo of almoBl U C. for fiftren minaten tuatmonpheric air, 

then retarD*>d it into the heart or vessclx of an animal jaxt AvaA lunl huug it. up iu 
a room wtturatMl with umiHture The bhK>d n'ni;iinii«l liqiud many hourn iu warm- 
hloodttd, many dayK in cnld-blouded. auiinubi. During thlH tinto a drop of blood drawn 
from the votweU ctnignlau-d immedUitely. If a [oreiyii budy wan iutroduoed into 
the T^-MU'I. th« blood coaguhiied only in \Xa Ticmity. 

\\V art- iii'lvbteil to At* Schmidt for the dciuouBlrntion of tho fac-t, that Qbrin 

I it« uu>:iii m the combiuatinn uf fibriuophistiu with Qbrogenetic matttrr. 

"hat blowl-oelUnro the !>carera of Bbriniipliuttic nuitcriiU is kimwn from thin, that 

^lutioii lirvt be^na in their vicinity and Rpriindo honcc into the remaining' liijuid. 

D, (ram the fact, that bloodcella iu giving rise to ooagulation act dilterently. 



150 



PROPERTIffiS OF FIIJRIS: QfANTnT OF LYSITH. 



after icttirfflrnnee viUi th^ir nutrition, e.g. in nnt bein^ ahle to talie up niitTIi 
oxygen, llence. it muAt lie admitted that thoy cannot develop flbrinoplastic 
Btauce in a nonnnl m&ouor. in inttamniatory affections, to wit, of the thoracie 
orgauM. aiid In npuoii ; the effect iiiii<tt be greater in the Muaultaneoiis increase of 
fibntj^nBtic substance. ^Eow ooa^latJan of the blood tu such caM8 is neTcnhdcsA 
Icnonm. 

In ^neral. tiio slonrer the coufralation, tho softer, more frclatlncrax and xa<wv in- 
caimblc of contraction i» the cong-alum. and no maoh the less Qbrinopla^Co sab- 
fttuiiot; there wa» iii the Htjiiid. 

With teK|ii!cC to the inllurncc of ^vtcA on the ciiaj^latiaii of the blond : — the pret- 
ence of carbonic iicid r<.'tiriln coa^ilatton. In thia manner alxo nther weak acvl) 
act. 00 well a» alkdliev and alkaline salta. Ox.vfreo and acmofipberic air bare nu 
direct influence on coasrulntion. for blodd kept a whole wcok in the air retains iU 
eflicienoy. Coagulation i» retarded nut from the want of oxygen but liy the aocumti- 
lation of i?arb<mic acid, aa wrII oa by thn tiimnltaneimFt deter loratiou of Gbrui»- 
pla^tio activity. TrAnvnidates remain fluid li>ii;><'r in closed cantiHii uf tbti bo«l/ 
than in tbo air, l>ocan«e the oarbonic acid cont«ino-l in thorn cannot escape. 

CoagiilaCiou \a prumoted by contact with the air, with foreign ■olid bodiea. tyi 
temi«rature fcl€vat«d to .w' C. 

BliKid which had tieeti taken from animaln half an hnnr after death, always coa^t* 
latcd much morn Mloivly thin thnt dmwn earlier This gnidaal low of wiiergj' in 
spontaucoiu* coiffnlation is the rule in blood from the dead, especially in Lbainf 
tiiosc who had died from f4uffooation. 

Aooording tn Al.. RciiMriiT (l)orpat, lS72l. a fkkmbut aruies in the blooii with- 
drawn fniin the vi-ssel-walN, iiiidur the inrtueooe of the blood -oorpu sol ta. which fer- 
ment iniluces corigulatiou of fihiiti. Tim fibrincgenio ami fibriuoplaatic enbRtnncet 
furuiMli the ui&tcriul fur rcruicululiuu. which mbetanoes ttiitvlucr miisl bu cxiXMxi 
to the inflneuce of the ferment, to induce flbria-coA^iliition. The autioa of lb< 
blood-oorpnsclfw on fermentation dopcndR npon lucmnglobia, Mont trannmlnto 
taken from the oavities of dead bodies contain both generaCom of fibrin, and iw 
ferment. Thoy coagulate on the addition of tbo fotiueut. Others, in whlcfa 
fibriuupbLHtiu Hubstaaoe iji wanting', require ita tiupply for the prmlucuou of tpMigor 
lation, Xcutral alkaline lalts interrupt, tow temiierature wholly preveutM ooaguhr 
tion. 

According to .\lANTRfiA7.7.A {A»n. unit, di iiutiie.. CCXVI., Apr. 1S71, MlUnt. 
co^culatiou of the blood and of other ooAgulable liquids depoada apitn n st&teof 
Irritatioo of tbo wbite-corpLntcles, which. In uoutacl with foreign bodiojn or intlaiotd 
ti>i8ut!8, oreapecially, if ttiyy are removed fmrn th^-ir pliyHtoU'(fic-.il oonilitinnD. tw-oreu 
a Hiibsuiupfl, which ia itstslf fibrin, or the canp»< of tlie formation of fibrin- 

.Vccnrding to BtiLL (ArtA. f. Anal. u. tftji*.. ISTO. p- TI8) the blood and waoim 
Uuids of the cmhrj'o are incii]>able of siiontaneons eoagalatiou. 

The tluidity t>[ the blood Ik di*|>endeut upon a normal Htat«t of the eodoUmliam . 
and affecUons of the endothelium, in which the cells need not an yet Iwve lost 
their Titalitgr, are cauaen of coagulation. (See lMFL.iiuUTloa.) 

The QUANTITV OF LVMPli is not kiiQwii with respect to the whale body, 
nor with respect to smglo oi-gaiu and tissues. Many ostiuato it at fruio a 
fourth to » third and more of the whole weight of the body. It namrally 
vanes with the g^rientl and local ((uatittty of the blood, with the Activity 
or rent of the or^aii, et^\ Not etpially striking are the tltirrroiit rvlutiona 
of the quantity of lymph under pathological coadiciona. (^ttw Dhopst.J 



( 

i 
i 

y 



OF.NKTi.sirn {Arh. am, d. ph^s. Annt. tn L*-tjaiff, ISTl. V.. p. M) found not only ' 
that during artiQcial circalation in the eurviving mascici of tbo cxtrcmitioA trac { 
lymph is still prodaocd, but that also there were great diffcrenoea in Ita iiuanlity, de- 
puudeut upou rest aud motion. Duriut; muscular a(.^.inn from elecuic irritiiiJon the ' 
q(uuitity of lymph obtained from tumluiis and fuHuitu, in many IrtalH and with ani- 
flcial circnlation. was more than three times as gieot as that obtaioeJ during n«t. I 
A coniriderably greater qua: tity of lymph was coUeotcd during paastive motiou tluu 1 
during controotJons induced by the gaJvanic corrent. The presHure on the lymphs'Ic 
vesaels induced by muscular mOTQmcnt«, is, probably, not oa important a ranac of 
ftoeeleration of the lymph-stream as the tuasion and relaxutirni of inudou" aad 
•ponenroiwA connected with active and passive motion. Still more striking is the 



0raciTI.ATlO» IN THE TIIOBAOIC CATITT. 



157 



Ufforeooe between the quoatity of Ij^inph excreted iludug tout and motion witboat 
he employment of artificial blo'>dl«ttiu^. 

LnsPKR (JrA. «iu*. rf. j>f,tf.i. Aunt, zit Ltipzig. 1873, VI., p. 04) veiy often observed 
ioiuid«rttblc iiu-intitifa of iymiih tlow in a yr-.ty oontinuouJi stream from the thoracic 
liiot <if dtigK, wliu>-e extrmiitiftts biul been cumplot^ly panilyied by eurnro, utd 
rhose et'tmacbs aiid small iiittietineti wen: fiee from fuod. Id a dug aftucfaMiug, '^■il-y 

2-JSGO grm., with 183.i grm. (bj-putbetioal) of blood, 313 C. ceot in 4 honrs, 
S4750 " •• IIHM " ■• '• *• soil " " 6 " 

15300 " " iKW '■ " " " ail •' " Si " 

llWOO " " U3l '• '* " " a37 " *' 71 •* 

oean Auw p«r mluutu woo betwufu mtd 1.34 C. oniL, moot frequuuUy O.S to 0.8 
J. cent. Tbp :ieciilijiritv uNo of thv aiiiiiiiil prubaVjy played a great part lu twooasoa, 
ympb flowed foe OU miDDteit after detith uL the heart, u'ith almost the sniiie rapidity 
rith which it bad tluwed a abort titui^ bufurc. ThiH, ncixvrdiuc to tbt: author, w tbo 
tMult uf the varyiujc preBHuru wh.nh nrtiScinl re^piratiou cxdrciKeH on the abdomen, 
uid whioh, in otbor cn«ei), in canned by tbA artiflcial ext«nMon uid Ocxion of the 
imba. When the paflt«rior extremities were aimultAoeounly tiexed and extended, the 
ympb-currr-'Dt. as OcMlflttticii hod already diiioovorcd, wart ench time coiui.dembly 
iwiftf^r than during rent ; iu mmy experiiuunl^, in thu proportion of A. 7, or AA\, or 
1.0 : 1. Lymph wluufa Ho wed duriuaa Atalu uf rust wimIu motib cuaui upulum^mt i.frum 
'atiy lloculi) : that, on the other baud, obtained duxiog motion, wai^ entirely ck>«ir 
ir slightly milky. Tb? bitter, tmnirparent iyinph, prooeeded probably from ttio po»- 
«Tior extremities, the former from the abdominal viscera. The lai^o aecrotiou of 
ymph. which appears during ]Kiit<uuing \rf curate. In couucctod with lowerin); of the 
llootl-jirett^nm*, ho ofleii otMer\-ed durinfr the action of thiH |Hjiiion uti dugx. The 
K:<MlerateiI lymph-currant and lowering of the blood •pretMii re dojieud ui>ou a con- 
[eaaian of the abdommal Tiaoera. 

TiiE c^iKi'ULATiOTC wiTKnc TfiK L'AViTiEfl OF THE BODY deservcs an especial 
toosiJcratiou. 

In the TUOK,vuiL' cavity inspiration greatly promotes tbo streaming of 
renoitB IjIoui) from ull the vessels of tku hady iiit<t t)io heart; usTtii.1 expira- 
AOti exi^rtA ii(j cHHi^iiliiil iiillniMK*<-, wlitle lulKtrintin oxpimlioik iictJt hh a hiud- 
'auce. Bosid«* this ii.spinitioii of the bluuil, eajwciiilly fniin thi? vrtweU of 
Jie neck ami heail, lUsturbuuee^ in the lusHor circTilutiun arc la inspiratiou 
'«Ueve<l: tiie liitigs fJcvrlup at this tiuic, and the rosistaiicni in tlit' moro 
>b9lructed ves*_'Is ileicivaae. If expiration Ub lou" prolonged, as, Cf/., 
U iuipaircd elasticity of tho Iiinga in vosioular oinphygema, hindi-ances to 
Am eaiiunce of venous blood into the thorax inct-easc, the veins of tho 
teck dwell, etc In jirojiortion as the elasticity nf the lung tissue fnilB, 
Jis pressure of the air iu tho tiingq iucrea»f» aikd rt*nders luoro ilitticiilt the 
tircuhttion of thn blootl thruugU thi;ni. In tho art^^^rios ^Itirini;; insj^iratiou 
Jjcre is a lo^'erittg, duriug expiiution an elevation, of thu bleud-jU'L-sstire. 

The condittona in inaplration arc important oa rcjirarde injnricii of the )nt>;o veins 
lear the thorax, siuoe the central cud of 8uch ii vein »uckj^ in air during in«pimtlon, 
nuidn^ the greatest diKturbano»» of the circulittioii. and eveu intitanlaneouB death. 

By paaniuff a Ktrjam of blood through Utugx whioh bad lH3«n removed from the 
iiorax. it ww observed that the «tream ptuned alowly into tlio or^^w in a ooUapved 
itAte. qniclcly into \{. when modcruKily diatcoded with air, ond when the InngK were 
Full7 diatouded the utream at f)t«t paM^ed ijuickly, bat soon became alow. I LUDWio. ) 

In the fftANiAL CAVITY the hlooU-caimcily likewLii? vnrie.s. In children, 
ivhen the boncv of the cranial vault are movable and tin; fontfliuiHes oiwn, 
fining of the brain during expiration and its sinking in during in.spiration can 
l>c sci.>n and felt ; a pulsation even of the brain-mnss con tlien- be obt;vrveiI 
in •oaiA csMH, juttt aa in adults after injury of thu cranium u-itb Iom oi 
rtaace. But the cinnium being eluiied, tliu explanation uf a Uelicient or 



153 



OtnocncATiON is thb cranial OAvrrr. 



full supply of blood to its contents U mui-e JUBcult. Tn dead Itotlien iif 
luiuhK itiitl cliilJn'U, iMur call bccoini; CDiiviiir«H] of the mo5it voriuuft ilfgittx 
which cxiKt with i-erc-rcuc^ to ihu blood -.sup ply of th*« braiii. And Um 
great effuMorm of blocwl, PXiidationSf tumon*, etc., could not ftri»? in the 
hrdiii, uidpHK room for thein could l>e found within the crAuial ca^itv. 
Finallyt ^he incrifUio nnd diminution of rho tilling of tbn vossiils have l>oi>n 
JtL-ectty proven by microscopic exuniiuation of the pia-iuat«r of living ani- 
main throu-^it a piece of glasH hermetically fuAtened in lui opening in the 
tdcnll, luudtf by m. trt»pliitie. 

In jj;'-inTal, tlio ciAiiiiim of adultn is a clos*!*! inmiovablft capsule, fillfd 
by the brain with itn meinbniuex, the cerehrn.spiriiil Hutd, and the vefwls. 
Tht> bniin iKt.p]it-fi incitnipivsailde. If we admit bnun-preesui'e because wr 
See the bniiu dislnjgiMt by depirsiicd bout', bliind-rlfiiHioiis, exuihitiuns and 
tumors, ibcrt' is qa^iitiuu in chronic dutoa, of atrophy of the bijiiu, in 
acute ctises, only of displacement of movable matter. The lutter can be 
only the bloud or cerebru-ntpinal Htiid. BitLer uf these uiieil be dinpliicetl Liitii 
the Bpinal canal, which in cajiable of slight expanhion through the fbiHticity of 
the intervubral li^imenta and by the possibility of a Huddtni depletion nf ihfl 
blootl of the veins of the dpinal cord through the inU'r vertebral foramiiu. 
In the biitin, it lUves not biip{K!n an in the f-pinal cord, that there is » con- 
tiuuoiia xiib-arachiuiidal Hpuce, but hciv are found many largtT and wunller, 
only partly connected simivs. The largiT of thejie, iM^twecn the crrebelhim 
and medulla oblon^ta and undi-r tlie pons, cerebral ciiu-a, fossjp Sylvii, 
etc.. connect ilirectly with the sub ftrachnoideal space of the spiuni cord, whili' 
tliH Rinnller conneet in pi»rt with one another in thi» correHponding •mkn, but 
not with the Urgi.>r spUL-efi. Flithor the ui-achnoideal fluid flows thiou^h tbe 
lymphaiic vcs^sels into the ueck, or through the counuuninttiona with tlie 
lymph-cbaniielB of the three higher orgauH of wnso into these. This new 
of the relulioti in*ntion'-'d between the blood and tlio cerehro-Hpinal lluid U 
aUo ftupporled by the fact, th:it in dif»ertiou the ipmntity of the lilmid of tlio 
bruin iH found to bo in invonie ratio to that of the cei^bi-o-Hpiunl fluid. Hut 
it nmtit always be admiti^d, tliat the beginning of changes in the qtiantity 
of bluud iu tlie cranial cavity, ia rendei'eU difficult in comjwrison with othnr 
organs. 

PrtVPEns, in tlio aboTO- mentioned eTperimenf*. showed that by Incr«i»iiig tbe 
prcKsnrt; <if L-x]>inition, a vi!h<m]I of 0,04 iniii. diameter fiilarfjoil to 14 mm., autl on* 
of 0.07 mm. to tl> mm. ; and that in th«> sud(I<:ii dci)riv:iti>>n of blrhwl, the vmmJi 
oontractcd from 4t( to OMS. from 0.41 to ,J1). Irom 0.18 to 0.14 mm. 

ThccLTi-broopiuil H-tid, the spiral oourae of the fonr groic arteries of tbe bmta 
before their calraiice luto the orantol cavity, their conTipcti-Mi with one nnotber uut 
arrTiUif^meut, i*o that all the vflwsetit are lo:^ in tlieir braucUt^'s Ui the piu-mnUT uut- 
riile -tf lb- brAiii~all thf-te r«milt in t.hi«, that within r'l - t-^ i»r thr hrain oad 

ftliinnl mrA ortfrial IiUmd ituwK iinilMr prnjairtinnalt-ly s .re. nn'I that it nUo 

shows only in ii. vory mo«lc'mt4) mnnuur thr perindio eha:i_ '■: jiu-^ure »f the jmlae. 
To thin npp:\ratii<t heloiij^. perhaii«. t)ic perivnAcnlar Iruiphatic afiaecd, wliicb eommq- 
tiicate ftcely witli the peri-eerebrol spnces. and ihr'iii^.fh thmie with the lymphjtie 
tbhiwIh of the pia-mater iHin. Zt»ehr. f. in'tn. Zo»l,, Xli*., p. 127). Aeoonbnjf to ItriUU 
( Vtrch. Arvh., XLVll.. p 31H). the veins of tho outwr Rarfiice of the durn are sotntK 
how in open cymraimioiitirm with the neron* cavity nf the brain. Probably tnis ia 
cffoetod bv nieiiUB of n m-Lw*irk of lymphatic ve-^olH, whji:b opi!ti on the iimur sutCoce 
of tUe dtira. hiit on tt»« I'tlunxidt; i* in diro*?t uom^iuiiioation wilii Uie vcm», 

Tn thf brain the nr:tuhnoi<l iHM-iinrar't<Hl from the dura by a capillary lavf-r tif lii|atd ; 
ID tSe ipin.'d mn^tl the st-roni* t'Jivitr in rt'docird to nnU ; the arachnoid li<;» tmiii<MliaU>Jy 
vipon the 'hna. Qlmsckc. (.|/-nA. /. Au-nl.. t*hif*.. etc, IH72, p. irilJi inject«tl nn eioid- 
sioQ nf oiimnbnr intovarious piirtx of liviag nnimatn. into the nub urnchtioiil Kpiior of 
tbe iip'unl canl. inco the amobuoid and NUb-arachuoid spuoea of the brain. A comma- 
nicatiun was thai first abuwu to exixt butweeu the iub-amohnoid tfpooea of the brmin 



I 

i 

{ 
I 



4 




Bcaidva, tbo camnt poxat** the orrTJcnl lympli - g]tui<l». in the <1ng- the 

irior »a>i ihti tiuixilUirj' ^Uuidit. Further, ttmii iicuwutuut of thr urachnoid 

lohnaiil npaaen tbroa^h the Paochicmiun gmnulntigtiR (A Kkv ami Rkt- 

\al\y. tho Butvamohnoid fluid iti ri^gaMctl as jKUriinj; cnnHtantly imil nor- 

■Iii'Ath nf the ojiiic uorvc* ; the latter is n iirojcclion with yiirKniijf walla 

rhnoiil Kpooc. Coloriu)^ lUAtt'Or U alwnj-s lonni) moHt coiiMtuiitly imd id 

(jnanLily in the Kiih-va^tial .i|>:i<% (I'.f.. in t.hr itpaoR Ix'Lwptiii the nxt^rnal 

.il Mhvatli ur tlm optic iiervfl. Wlicthur tliM siijira-vngiiiiLl lyiri|th-AjMicf lUwi 

«!•&*.■« Ix'lween thy ext^raul op(ic-^ht.*ath uiid the >/(«*f. nlrtu:un- bvibt) 

cnies anteriorly with IVnon'R space. jHMtcriurljr with the araclinoid ffpaoe. 

$iuu. Tqu lluid of Lhe sub-iuuahiioid i>;muc9i of tho broiu and ^ptnal L*ard 

iiihtiB the couijfuLive tuMuu Ktruina of thu rJinrutd pIcxiiK. lu-vur Lhu vetilri- 

I bmin. On th« other h.ind, a contiiinnl ciirrr:nt ft)ij»t!nm to cxi^tt from out 

Tlh Tflntriolo intit thn mih-nrarhtiotd Rpace. Mngf^iidifi'A foramen, (to-cklled, 

dcK'ftnot i-xint. Thrt wnyn of roinniaTiiontioD lie in the intcniiodiiito ipiUJeB 

Siuj(;ctit(j-tiw*ne tnttthoH wliioH form tht-i pia. iQiimke.) 

lit Al,TU\SN, Jtrf- Krei4,iftf ill rkr SfMrtrtriiflgmd'ho le. 1871. 

liiifT to LtBRtRMKUTKit i/V'/f/. VJfifc/tr.. IS^H. III., p. SI) the real function 

feroid gland U to nigtilaUi the supply of bloo<l to thii hmin ; tlm aj^u^ta 

IforoiM-Aeutinn of ito four urturir'S iH not intich \chk thuii tluil nf tht* ArtenM 

pnrhle for the bruin ; an to the bnin, blood in ti'.i*o seitt tu il frum i^nch of 

Inr^ arteried destiut-d to the npiM>r hiilf of the body. Acconling to 

Eod Gl'Von, the thyroid ^luud bwcIIb diirlu;; ntiun^ blond-premurc and 

I tiio carotids, tltcrcby j pre Tenting; a too grrat Ulood-preaRnri) in thu bmin. 

ABDOMEN, eHfKTulIy ID the vena portjn, the eonditioiiH cf the cii-cu- 
rti ill ji^'iiemi inijKii'tJint, l>cettiisti of tlit- givnt c|iiantitv of Idood 
tfi vessels, and in |>nrticuliir bociinw; of the theory of Im'itiorrlioida, 

I congestions, abdominal plcthnni, etc. Th« «lM«'iice of valves in 
nl vein reiiden* it ceiUiitily |ii>«>il)]i' for tlie )>)o4jd, liimlercd iu its 
flow, to rtftiira easily oii'l qxiickly into the roots of tho vein (tlio 
loiilul veins, etc.). Bv this also is the cii-culation ecjualiretl, and a 
loidiiJ blueding can the mora i]iiiekly dituiiiish the prewiiii-e on the 
rHl*<ni. In a Himilar manner ia explained the awfllint; of the 
uinn;; dijeation : the blood L» ci-owdt-d into the Rjilehic vt.ins, ho- 

lliis Lime tho giistric and inli-stinal bnintdies of the (>ornU vein 
largely biijiplied. The slower ciriMdatiim in the porljil vein, diia 

tAiice from the lieiu*!, and to the piuisago of the blood throngli a 
tvscem of capillatnca in the liver, is assisted by the respiratory 

-1 -*J *■ J_* l^^-X 1 I »1 * 41 



I3*Fr.L'ENCE OP NBRVES UPOX THE CTOCrUniOJr. 



Concerning tlif^ dkpksdknck oi- the cibcllatiox upon the nerves, lh» 
following [(ointB are woi-thy of Htt<*ntioii. 

The cftrfliftc ni-'rves arine — not incliuling tli(! intrii-cimliiil niTvc-cnnt 
from ibe eorviftil jtortion of the Bym path otic, ami from the vagus (froi 
its trunk as well as frotu tlie rociUTont uoi-ve): both nerves together fori 
the cardiac plexus. The vagus in the nerve of aiTe«t, the symifathetic thi 
exeitor nerve of tlie heart's motion. Section of the vagi in the neck 
cauHoa ail incruaae in tho number of the heart'it t'OutractiouH, two-fold and 
more ; ni<Mlerate excitation (mechanical, chomical, or electrical) of tlie «ami 
ner\'e8 diminishes the numhi;r of coutraction.s, while strong excitation 
followed hy couiph^tfl cesHation of th<; heart's movement in iliniitolt*. Irri 
tatiuii of the niiidulla oblongata, as well as of the upper part of ihv cervi- 
cal ponion of the spinal cord, acts in the sauie manner as imtation of iho 
vagi. The effects of Irritution or section of the 8ym|>athctic are leas 
certain: the former causes, for the mciut part, an acceleration; thu Utter, 
contiunoUH loweriui' of tlie huart's contractions. 



Tiie noiiHtnnt excit-ntion of the va^ in warm-lilnnthjd auimaln ix RRVLKX in 
cliaractcr {BkhnstkisI- Of tht» nlhur rellcx iiritiUons o( the vagan, are known: 
mechauioal irritation of the intestines iu the frof; (Qoi.TZ), porha|M aUo in inauf 
caaea ui mno : irriution of moHt variou<( nennory nerves <I>ovix), bat only h> \img « 
the evrebniiii is iirewrvcil tOvoN) ; alio irritatiou of the lrij*eiaiii«» l»y chloroform, 
ftmitiiniin, ut*:. (Kuatscumru — IlEltlxa, M'.'tn. 'tc<i<l. Iter., lS7i», LXIL ) ; that of tia 
abilomtnal anil iK'.rviual conl of Die Kvmpnthotic (IIkknstkix^ of the ragwi of Lbff 
Other side (Uk'/i)1.i>. ktc). Modcmti; expaniuon of the \xmgn iocroaaee the hMiVs 
beata; not in oortuciinenee of increaxc-d preoNure. etc.. upou the external aarfaoeof 
tha heart, hut in a retlex luauuur Ihrout^b the vagi. The acjuoiy ner^■ti•tibres of the 
lunpt, irritatuj hy tbia tiX]»ausiou. act oo the cerebral eentru of th« iiiliiliitur; ueirat 
of the beart in n miniilar iniinner ax not the fihreei of the (lejiretwor nerve on tUe 
iwrphml i«iitrn of tin* vtisn-mntor iiervpH : both lyntres ar<i in n Ktate of contjunal 
excitalinii. which is reilucoil br irritation of the nerve-fibna mentioued. These 
flbri'p am thus Uu: iiurvL'» uf iubibilioti fur tbo.«j cuntnw (llKnrxo). 

Di;;italiH excitUM the iuhibitorjr iiervi>ji of the hurirt. and the ]wriphcric uxtremitiiu 
of the vagiin, Kiuce the action alno ajipeanii after hection of the va^i ; thou it reduces 
the frequency of the pulne. Atropine paralyzea the nerveo of inhittilion, and ihaa 
the pulae in iacreaiied in freijuenoy. If atropiue ftr»t ami then ilifiriLtliH !« iajected 
into an anitntj, uo Uecrwue of the frciiuvuuy of the pub»c will bo observe*! i.Bo- 
Bcarohea of TitAirnh:, Ulkuld, AnCKiiviASN). ]>(>i1ii:l saw tliu beart coma to i 
Htambtill at the bi'^iiming of chluroform inhnlation. 

A branch of the Tiigan discovcrefl by LrhWHJ nnd Cvns. mofltly from the snperior 
hiryn^feal, the nerP'U dfprrM-*r (whieh pa-^^am from the heart to the nervous ueuirv 
of the v«.-»MiJa iu the spinal oord), prob.kbl; dintiuiHbeH the reitixtaaoe opi^oKia;; the 
emptying^ of tb« Ijtood of tlie over-fiUotl heart. Trritation of itM ceoLral and is fol- 
lowed by diintatinn of the vi!Hs«1h and tliiniuntion of tiloocrprcuure. Irritation of 
Its peripheric end. a« well an aoctiou, la without effect. 

The pErENPENLK OF THE VKSSKi,^ t pos THE NRKVE9 conwjdfl in thU, that 
the latter hei-p the muHcuIiir filircs uf the arteriea in cuUNUint tonic con- 
traction, HO that, an iictive re-si-itjincc is oppoaed to the expansion of tho 
voaKelti fn>m litood-pit'a.*(tirc. Thi.s continuouH exeitntimt upon tho arterial 
wall is exerowt; I by the sympathetic. After .lection of this nerve in the 
neck the latei-al pres.sure of the walls of tha I'easels instantly diiuiniahea; 
tlie blood, in (iro|>orl4on to its pressure, dilatiM the arteries, and, farther on, 
the capilUries of the cori-Gapuuding fli<le of the head, am) runs through 
them with such velocitVj that, since nutrition does not increosto with the 
(jUKHtiiy of blood, it duea not become venous, hut remains art^iriol, and 
that besides, aluee the i-esistanee of the arterien ia dtjstroyed, llie puke 
coulinues into the capillaries, and even into the veins: in cguae(]uenc4 
there occur ruddeuing and lui olcvation of tomperattiix^ from 3^-4^ 0. On 



m 



( 




GEXKRAI. VASO-MOTOK CKXTRB. 



161 



tbe oilier honfl, irritfttioD of tlie 8n[i«rtor cervical gangUuD is foUowed, but 
more slowly, by coiitractiou of tlic same veBwIs, [JiUeiifHij nntl lowt^ring of 
the ti.Mii[Mnitiirc. Tliefie iuliuenees of the uervea o<x*iir phvuiologireilly in 
bluoliiiig uiirj ill imleiiiits. (Both fora's huvt* no inllurncc iijtnii tlic rulibi-e 
uf thi) VMinK ) TIk" (lirtt-rfiiic-eft in the tein[H'rjilinf of the sick oml lit-wltliv 
sides Again rr^'di' ti> th^ iit»rnia] coii<iitioii in the aniiunl under ex- 
peiimeiit, but Iwcoiups |u-oiniiK*nt ogiiiu ilniiii;;; lu-tivc tiiuvomoiit-H. The 
diflfrrenoca nit* »^s|KvialIy strikinjj; in culdii'-ys, loss uf bloud, pain, iu nhoi't 
ill nil tlii>s<- sijitfs which mark wwikucss iu llie uuiuiul. 

InveiUjcatfaiu by Dvptrr tlSIH), eapcGially however bj BKUXAUt) (1848 ftnd 18^3). 

mk« hf ItlUW-.K, VVaI.I.RS, BROWJt-SfcqUAUD^ SciUrr, T. cL BECKK-OALLHSFKIift, 
Do.NDK.KA. ami otheni.* 

The gen<-ral c-cntiiai. oaoan yoR nic nekves or thk vesski^ is la the 
medulla obloiignia: irritjitiun of it iu the luiiujunHl npiual coul and sym- 
jiathfiic in fnWawtal by contraction of all tho smaller itrtfrifH (uith cuii- 
Recntive hi<;h rai^in^ of ilio Idood-jtrossure in tho ai-ttrial brancht;^). This 
constant irriUttiun is prohjibly due to the influence of the carlxmic acid of 
the blooil. In Hulfucalioni the Ranie strong coutriui-tion of the unmller 
arlerif'Ji tak<*s place from a siniihir cause. This tonicity of the vessels is 
destroyi'd by section of the spinal conl in the c»i\iral region: all the 
miracles of the vesaoia of the body relax, with cout>i<i«>rab]e fall of blooJ- 
presBure. 

Anmnlinier to BnmK (M^l. CtrbL, 1WJ4. No. 9.>y, thn ornlTc of tbe Tawo-motor 

Dcrrrii U«« in thr ctrtibnd [ii-dunclui ; aocnnlin^ to othon, iitiU tiigfa«r, in the oeie* 

^KDi ; thr Intfr mn>T at least exoroiM! on innn*-nc>c on tlint centre. 

^Hftwiu ^NMKow \Arb. an*, rf. ph//". Aimt. r»( l^if'H'j. 18T3, VI., p. 31) has cxpori- 

^RntAlly eix<TuiuiH:-rit>C4) the localities from wbiob the vnso-motor ncrvoa reouive their 

tontts, ubil iu wliiijJi they ri^ueive ibbir rellex t^xcitatiuu. In rabl>itit and cttM the 

apper limit of thin loimlity in \-'2 mm. b«luw the oorponi itaadngomina, the lower 

4-5 mm. ahovr the calnmoft wriptoriuH 

Accordmif to ihM.v/. i \'irch Arrh., XXIX . p. 394), bo«ido« the mtKlnlln ohlon^tA. 
the spinal ou'il ali*o m throughout nn m-lt^pendi-Dt c«uCrRl or^nui for the Toao-motor 
nerrpK. This hjut rPMiilly 1h;kii roiifiniH-il by IlKrHF.l. i Wtr/i. AifA, IHl'i. l.VI.. 
p. 34^1. Accord fill; lo hiii uxjiuriitiuiiUi on ihu fr<»fr. dvstnictian of this metlnlhi 
ohiouffnta and ni'tutU cord cuust:» ihe circuluciou of the blood and rw»or]'ti<»i to cca»c. 
wbilitt by reiDoral uf these or^g^oiis the octitinuul state ot excitation of the whole 
oyrtem of voHo-motor nervt^ in Jcstroyod. the sinooth-mn>>cltM of ah (he TCMeli ore 
ntlaxi-d, Lhti tunui of the vc»>t.-U, and witli it Um tcnirioQ of Uie blooil iu Uie Temula, 
tadMpcnhHbiT lu'oefMn.ry to the uirunlatioD, tlijuipiNiaiB. 

Accwrduipf toil. llwv/. iArb. itim. il. Lfija. jJii/*. Iimt . 1870. p. W) contraotioa of 
thf iOtcrics of mu4uli^a <lut.-k iiC't >^t imift>rHily follow iiittutlou of thu spinal oord. lu 
M the Oil ^c with other uttcnc^; it t-< :ilwMy.<) abstint in poii«oning by curart;, while 
other artiirio* aro o(>ntnu;ttd. Thi; va^o-moUir iierreH of inniuj)i<fi iir« mom esiily 
exbamrt^l than oth>-», 'u that rvintrnrtion appearing' during irritation of the spiuid 
cord very •*>k)d pckw»e« into 'UUtutiou. It fnllon-ii, ibcu, that not oil nrterioK are uia- 
torially contmcted durui^ irritation of the «pmal oord. Thi* ta certainly true, how- 
ever, of thu fGkMU of ibe Mkiu ami intentiiies. 

Aw-ordiny to S. JlAYF.n iOn>tr. mril. J//.. 1S72. p IIU itrychnta canieii a oolosnil 
increaw; uf pririKure in tliu nrtorial *iyst«in, which iliipunilK upon an oxtrAonlinarlly 
{nt«niw initJition of the rnpto-inotor centre in the brain, and the resulting oontraotion 
of thcanittll nrt^^rie*. Nitxitinn (SciouN.HKlf, ^. /. rat. Mfi, {,\XX.VVI.. p. 21 1) and 
Calabar \wsui i ItK^oun aud Q •T/., Mcti, ('trfU , I^MIT. p. 212/ act in a tiimilar nuiuuer 
Aooordinif lo THAt'UK un habitual ubo uf alouhol and itinmltaneouM iitrou(r exertion of 
tbeutasclen. ai«o Uie exoeeaive uae of tobacco, diminish the toH'm of the arterial 
ULtiKiiea, aad thus the flow out of the aortic system, aud cauwa chronic oudnrteritlik 

* llK<iw:4-Si'QrARD'fl t>Tpi'rimciitM were cuntemporaneoiM with Bkrnard's (185dl, 
B.-S. ad\-.iuc"--d th-' theorv of vn-io-motor action. See Lonoet, TraiUd^ PhgtiUogi*, 
L IU., p. 013. Pari*, IMlh*.— lEu.J 



162 



TA60-M0T0K NERVES. 



Til n REFLEX UAKXER the artariftl tonus in txHlucod or iucreasr^ : gon^rally 
by irntntion of tlie centnd end of tliy deiui-ssor nerve, us well an hy 
iwclioii of the fl|»luiiu)itiic ner^-e (ilic va«f>-rnotor nerve of the vesMfls of tbe 
nlidoiiifjii) ; 1tH<Hlly, in md urtcrini iliNii'ict, by irritHtinii of tht? McuMiry uerves 
of the corif*si»oiiiliiig region. The latter rvflex excitation is. in liealtby 
UvlieH^ in iininterniptetl lii-tivity. 

The lAte of vascular rugioiu affected by Irritatioii of sensory iiervtw deiieDdit np<iD 
tlio point at which iL ia aEiplJed. The effect of irritntion of n at'Dsury norve doot 
not, OS a rule, extend beyoml the limit of its periphohc dLotributioa t Luv ij< i. 

AL-oonling to NoTII.VAgel ( Viri^A Arch., XL., p. ;JO;I\ the ajUrries of tin? pi:i niatoi 
DonLnict. lt,( ■■lr_'clrin;il as wdll aa hjr much tin iuii irrit.ition uf M'iirtor>- ni-r^r",. iiii^stly 
after irrituUou of the oruinl nerve. RTI1GI:l and JOLLY (//«., LII., p. '2\^) did aoC 
find this tn be con>>tnnt. 

Like the tranKveniel^ striated mnaclea of rcnpiration. tho TadO-motor ^atein of 
nervoa oxperienco^ a periodical innervation from the (tide of the rospixaloiy nerve- 
ccuttvi iu Uie intnluUa ohlonnnta. llencc periodical eontractiuun t>( the muKclea of 
the vetHeU result, tbi: M-called UEfl'uiATonr uovKMKMTf nv thr VAM'^n^n ststsk, 
whi(;h n.re uutouiateil with the movomuutd of ruHuiratiun (Heriko, IFiVn. Sifagtlter,, 
10th Dea, tbWf). 

Speciul vaKi»-iuotor uervo-cuntres exiat fur tlio vuriuus vnscular prov> 
iuccs. 



* 



AoGording to ScnuLTz'a experiments, secHouti and irritntionsi of the cervical syni- 
pathetio an^ ainnol oord show uu cuuslont iiitlaeucc apou the veaaehi of tho br«iii. 
Their nerves pro>iably take their origin withiii the crouiuin itMlX. 

"VprhpIs probably pnxsiws in tboir waJIs imiTR-ganpliit, which gi^vorti tiieir 
size. Tliifi is corrobonttcd iu part by the Hii-ccb inllucnce of tbo tt<ia|Mtra- 
tui-e, in [«irt by iiathologioit observation. 

Thn L-omlititMia ni«nttijiii*d n-hicli inlbienre bloncbpressitrft in nn impor- 
tant mannur nrc: every enlargement of th<: cbunnel ih followed by a lower- 
ing of the preasun-; every contfAction, by un elevation of it. Tlir* former 
occurs after jwction of tbo Bpinul coni, and after aoetion of the splaiicbiiica ; 
tbo latter during irrilalion of tho Hpiiiid rnnl, and during iriitatinu of the 
splanchnics. Th*^ nniscles of tho sruHll arteiitis and veiim in the whole 
boiiy, or in a birge vascular district, contract by irritation, fi.r^. of the 
Mp]aiic-hnic n., whciitv the arttrial blood-pre»«mv increuitca. For, in the 
tirst place, by contraction of the vewwls ihyir bKxj*! is liriveu to tin* n^it 
side of tbo hoart with increased velocity, and the right su\c and seconHarily 
the left side, in ii unit of tiiuo, contains more blnrnl. In the second place, 
contractii>n of the Huiall arteries catt»es iin^ieused i-eslstance at i)ie uud of 
tho artenal current ; the dit»proportion between the ipmntity of bluod ouler- 
ing the artorieit and the qnantity leaving them, in a unit of ttnii>, increimea 
con.sidi'i-iibly; consequently, also, the pii^sure of the blood in ilifl large 
arteries increo-ses. Finally, this diHpro[>oiti(jn is incrcjised by the activity 
of the bean, incmatted secondarily in consfpienee of tlio elevated inirm> 
eardiul blond -pivasu re. (TnveHtigationn of Lrbwio, Bkiter^ Dkeou*, Cy05, 
and otbeiu) 

OOLTK fl. ft) has already rendered Justly prominent the slpnlfloanoe of the actfri^ 
of tho raao-motor nerves, with respect to the velocity of the blood -onrrent. 

Accurdiiig to I)onu:i.V inv^■^4til;aUfplW on tho intluenoe of tlie nervts" upoii Ui« drcu- 
latiou of Uie IjIihhI in tliK lower nxtremiriuH i.lrtfA, /. it fjtji. y*Av»., 1^T2. V.. p. 130), 
there npp'mm during' irrit-ition of thoRrtiml or sciatic nervtwi a n"tnrd»tion of iha lilood- 
cnrrent, and an ©levulion of the bloo-i-preesLure in the femoral artery. A (irirae con- 
diCJon here is the ooutraction of the transverBely striated maiolea. Brery ooutraetiaa 




TAWy-MOTOR NERVES ! DILATOR 2ffKRVE8. 



163 



jtrcKini'i'B in the vcmsbIs of klie lower ftxlTftmitiei aflncttiation in the b1noiI-><ti-<>iim. i.«., 

tvtanlisc' it : bnt thin reUtr<I«>(l l>i>io(I-Ht[V»ni in i\nf nrtrrifK iinil vtMiir! of a limb it 
■ccoinpaDie<l by an acoolontion of iht* blodd'Rtnfnm in the other ojid quii't limb. At 
th« Muiif time a Hlourcr blood -cunviit hoii morv tim« for iatcrcliati^ vt uintcrial ; 
Ibuji more oxj-fi-ii 1» tHUi>aimcJ iiinl nn>r« t^nrbomo acid is formed, t JSy llua is cxiAahicd 
Ibr iitilitv or KCtive mid (i^iti-ivf^ (■yiiiiinxticn. I 

Exciiiiriori i>f spnjiory ni'rs-*« is fdUnwpi. fnr the innst [mrt, 1^ a rollox orintnLntiOM 
of nii »»*i*rl«. nnA IhTBtritli flpvntitm of hkK>d-prew«ure; om naiil uhnvi?, there npi>eani 
in Lh« n-jtiou of di'^t.r.ljuuou of irritAted neiiHor/ norrcs, mohtly ddnrntioii of tho tm- 
«cL<*. and thin way ^ive rice to a dt'cn:n»€ bt blood prrwfun^;. After romovtd of Ibe 
ccrebml lobea, nr after aarcotixatlon of animrils. tberc nlwuvs ariM.'s dilatation uf 
venflv oDir. nerer oontraction ; but this in not true of Ti-M-eU within the region of 
(li»tnt>ittioti of imtAird ff«iiiM)n- iit-rvHA. Afl^r t-xl.inmtKni of lh« wri-brrd U'lu-s or 
narc'tisntioD, irriliition of npnoorj' iiurvcft is fnllowrd iilwiiyR liy n dpcrpiiw* nf ItliHwl- 
pt^fMiire. but iiorpv to *o yrcnt n di'gret ns dtinng irrltatiun of the df;|n*Mor ntrre. 
<CY.iV ftud 'i. riT^r»f> Ar.fi.. XVI.. p, !i;, IHll.l 

AecordiTjg to Scilti'l', not ou\y iho aiuiiII nrturiM (Trnwio-TinilV), btit also the 
XtkTgf^ tninkft in manjr. prohahly in nil |mrt» of th^ body, dilnti- after Mwtion nf tho 
cerrical jiortion of the wird. The chief canne of the heart's f^-eblcncM and of the 
diiuini^bcd blo<xipreNture lie*. coniK-tiiKMitly. iu the increase of %-ohime of thf larita 
dilntcii vt-MclK, which in ibeir t(j>iici<>uH cbuiut<.'lH ictjiiu a frreat quantity of blorNi, 
which ••an tm loiiir»T p*tiini to r.b« lioiut, and thus i» withdrawn from the drculaUon. 
Rwrh an aniinnl i« tbt'rrfnrft n^lntivrly niia'tnic ; Hood iB wanting, Ijctraaso a (prcat 
qnnntity of it i* r<-ta»ncd nt tho iwriiihcrj". 

Aot'orliutf ui I'lcK (-Ifc'i. /. Au'il. Phy». v. xr!**. Mfft.. J8T2. p, TAIt), the- intflnaity 
And tiuickiie-*9 of ai'i>onr«boe of the rtllox couttaction of vmmIs oro in dirwt ratio 
to the 8trL<n{7th of the neMttory irritation. Dltferanl part>i <if the body need diffor- 
ent df|frr.'»!s of irritation, to call forth an e*pial cvmtraction of Iho vettst^l*. Tho 
timv of piintraclion and iti* tntt'nxity varj* intlircrtly t^' the i^Wiy of ih" vfswl. |')inti- 
nntioii in the rt'lodtty i>f thp nirrrnt (fm;* hand in hnnd wiih pontractioii. tlontiao- 
(ioii niotilly follows dilatation, which [*l<-U. dilfuriniic from Lovsln, fonnd proportion- 
ate to ttie prcvioiu cuntraetiou. Dihitatioti in a xign of txhamition. 



Vaao-moti>r n^rvM st^ldom nin an imlqteiutotit coiii'se, but are, for the 
mcwt |)Art, ntLtfil with otln-i- niotftr or sensory iutvps, going with them a 
jfTBftter or less di'.tinico, und tlK-n brniicliiiig from tb'*m to tlio vess^jls. 
Corufrtiiiijj the <!iHtrihnti<in nf thf VR,sn-intit<(r iiprvos in single iTpioli.N and 
OTgniii* of the hmly, w** ttimw with pi-^cision very little. In tlie Ucatl, 
iiioKt nf iho nervpR of the v(*sji<*l»i iravrl with tli<i trigi'niiuns; \h^^ n-iii:iiiHh>r 
are fnrni>*h>!d by the ccrx-jcftl syinpalhcHp, some also by the faeiat nrrvp. 
Th« OPTvtw <if the ves-wU of thy npper t«xtr«nii(i<?« (skin and mnsfloK} pass 
from the lower corvimi portion of ibe hpinnl conl tlirougli tb« antfiior 
i*oot» unJ eommiiiiii^ting KriLtichcs into the tliomcic cord of this Hyiii|Mitlictie. 
Tlickse for tlte lowt.*r extremities pa^s fix)m tlie dorsal poi*tiou of tlie spinal 
conl into thi? wicnil tvn-il of the sympHtlietic ; thone for the intchtinHS 
run in tho Hplancbnio iior\p«. 

Whilo tho nf'i'vw JMs( di*»^i-ibed uro nerv(*8 of conlmction, and beloug to 
the syuipnthniic, thrip nvv besides, for isi'Iati-Ml jmrtH of the boily, nhuvks 
OC muiTATioN which aris*^ innnoiliut^-ly from ciMTbro-Mpinnl r^jotft. Nerve* 
af tbia kind piuw in gii-at nntnbcr in lln* facial iirrvt? Ut the mticoim, lachry- 
nsal, and salivary •jlatHls. After irritaiiun of thp chorda tynipnni, tInM'« is 
8Ti iiftivo di-ti*nuinaiion of bloo.1 to the finbmoxiUavv phinds ; the veins are 
tilU^I to CXC11W with bright nil blood. To this cl;w« bt-long tin? »irrr» fntfen- 
ftc*. irritatiiin nf whioh c;inN«'H mi increased and nccelemt»>il flow of blomi to 
erwrtilf tiaaucB ; th*? blood rtowin^* out aO<r having (lUed the latter tiasue is 
briahl rtsl. IiTiCntiun of thes^ ut-rves cansrs erection of tbe penis. 

Th<- NERVEK fiiTPi.Yisn th*- VEiXft HP? aTmtomicnlly but liltli* known ; hut 
phvaiologicdl otjMorvfttiona t<istify *o the presence of the «o-c«llrd TONfS or tite 
VBtxa. Tb« latter^ like that of the arteries, is intbiencfd by the great u-^rve- 



1«4 



TONTS OF TEE VEIOT. 



centrttK. Fai-alyHut of ttie tunug iu a btt-ge vascular region ia, fi^m \mvA 
uioohauical n.'juiijus, follow^-il by u towiriiiig of tUe hcurt'a nccioiu l>c&cru« 
tinn of the brain liiu) upiuiil cuni aiTesLs, after a time, tlm circulBlion, ' 
cause witli a \o'^ uf tla; tuna* uf tbo vt^siH^s Uie ljeart'8 aution becoDu 
iuefEcaciuus, for the vutn-irn/n which tilln thi: ilianUtlic heart in tlitt UintAO'^^zj 
iu the voius ; if this ceases, the hfurt remains eiiijtty i» diiwt*>Ie, aud tit 
blood wasos to citciilutc. The tonne is sutlicieutly increiifMHl if cither tla 
merlulU oblongata or tipiiml corrl ts U-fi- Kestoration of tin* circuUtiu 
afU'r grt-ttl hisses of bltiuil lb accomjilifthtid iu great part by thiK tomtit. 



Oonmtlt GoLTZ (I. c). The foUovinfr cicperiment by Goltb ( /IrrA. /. d. gn. Phjf 
1871, v., p. 5C11 ishow-Bthat Ihti vcius like the ttrterias uoutract uuder the iiitlucii» - 
of the central ncrvott!i Aj>t«m aud force their conttiiilx iutu thu heart : If, from t* 
ftofns the lu-aiii wnd Bpitial c<ml are rtmovud from the one aud not from th^ oth*- 
and both arc aaspeiulftd }H;riiend:cHlarly and thoir iiorta> oat. ecarcoly a <lro|>of hicxi. 
eacapen from the runner. wliUe 1-3 C. cent, tltiwa from the latter. The mi^»eQi«r 
Teiim of tlic funiicr aru Huocid uud dilaCtnL, thL-ircoiiC«nt« stuk from i^'raviiy iuio \^^Me 
mtMt dv|Kiudtrnt |>urU); thu vt^iiif uf thii bloi^diu;; animal are uarrower. BKRN.-iTK '-9« 
{Itert. kUit. \\'»-Jir.. Ifil2. Nn. '2^] ]ilac<» anothi>r iiitcrprBtntion on thii expi!riincr»«.j 
It) the frog with niiinjurpd Kpinnl <>ord, the rw^ir'M'd tluid iu drircn by contra^ition «f I 
the vrttatJs tiiwardJi the openlnff of escape, ami dpace is thus provided for the Uqalt/ 
Hiiwiti^ out i)f the lyiiiph'Sac If, on the oI>li«r h&iid, bho xpioal cord hi dnilroyed, 
axid with il, therefore, thi» jKin'tr. tht; ctxiumUi ceaMt t1i«ir inuveiiii;iit in tba TstuuU, 
aad the tilight prusauiti qjk>d the liijuid iu the lymjih-Huc ia iuradluieat tu awroame 
thu obhtruution. 

The cAi'iLLABlES are without nerves. Concerning the influence of the 
XEitVE.s ON rnr. lymphatics likewise littlo ia known. It is known that ir- 
ritation of tlie nervoa ftecfKirat<Mi the flow of tynipli ulrwuly in the vttssoLs, 
but UL-vnr induces one uut [iivMiut. 

Section nf the curric^il Hyinpath«tic, which increasen the velocity and teDNcn of 
the current in the cipillarle^i, but at the aimQ time, by ttw warmlit]^ of thu tiisaen. 
reilucct frictiviri iu tbe cxi'Lllaries, m xoiae cotieM aucclorotes the nepamtloD uf the 
lymph, in othunnoC During the rcddcuinjf of the Mkin iby iujectioQ of liocl upit 
int<i thu Ycins) the blood -pra<»uro in thu camtidii ia ofbcn at thu same titav luweml. 
aad thf (lixcharje of lymph t» for thti mniit part oonBiderably inor^inaed- i brnwio < 

Aoi^r^nling to 601.TX (1. o. 1 there proceed); from ihu bruin and aptnal cird a foror 
by wbiuh. rkftor mterniptiou of tlio circulation of the blood, a mora abundant ^traam 
of liquid n driven unt of the lrm|ib-iia(.'i4 into thu veteMln. heart, and aorta. Thi* in- 
Hueuue of thu twntrnJ orguna 011 uhHur[ition may probably bu rdtlex, thriin|;b irritation 
of distant cantripotol neiTtM. 

Whftt ill true of the veinc and artsrieii, with respoct to nerve •inflnenoe, is probably 
tme also of the cootrnccile lymphatio veiaeli. 



Mncb I«*sh known than the inHufucp of tbo ufTvr's upon the ciroulniorr 
appDratu.t are thoso movkmests or tick hkart axd VEssKiJi wunii oririt 

rX»EPEST>KSTt,V OF THE XEHVES. TIu* moVemeutH of the llfnrl, l»Hsidr» 
bt'ing dc|»endi'nl un the nigna nnd sympntiif-tic and its own ganglion w*!!*, 
depend upon maufri:\l i'hitngi.*H tn itK uiuxcular Kulttttauot', nnd ujKtii ihtt 
unintinTiiptt'd nupply nf oxyu;ennte<l bhind : changn in ita U*ni|M*nitnm« in 
its ccintnined oxygon, carbonic acid, otc., induces changes in the movcmeota , 
of the henrt. The latter depoml, too, on the reHiat^mc^* of thi* luaas oC I 
blood, the uuuilwr of muvemeuti inctvaHing with ttiQ blood-prpsanre itj the 1 
orieriea^ otc". Thus, in goufrul, wp aurely know uumerouti forcoa which 
inHuDnce the hc^irt'N mnvenientM, but individually thoa« canuot with oer- 
iJiinly be tliHcoveicd. In the nrtericR, and pi-oi»ibly in the veins, motor 
phenomena are kuon'u, wluch atv independuut of ue^-voua inlliience. 




ttOHJEMIA. 

Sctttft ftnit obsrrred cpitckly nltornatiu;; contrnctfmi &nd expansion of tlte nrtenoH 
in the ear ot a mlitit. Tbfsc* m-ivtiimmts wurc uhwctVLiJ b^- ScniT.TZ in the nrt«rie« 
of the pia iiiaUr cor«bri, ami hy C'MINriklM in a tro^'n tooffuo They are independent 
of Tiv'^moior nt-rves < fnr th«'y rniitiniie unchiiiicfjJ. nft'T i^ection cf all the ftympa- 
th^li" n,nt\ ofivhro «plnnl norvi-s), of the hfirt"!' intitinu. tuvi ot respirnLion. A(K:uriliu|f 
to BitrNToN {Arb «n/-<, tl. nhy*. t'»t. z-t tt.)*:it/, l^'Sft. p. lillj ativh vii,cUlati<.iiH wenj 
oIho tonnd in nil other ex[>i>«ijd arUirial )>raiiohw!4 ot thu nkiu und coim*>c-tivb tiiMun. 

S^r'tU atrautiiift and erj^otiue aje followed iu thsir use h.v coniratittcm of the umaU 
arl'Ti*)', and Uier*by by i'lt>vutioB of hliiod-[»rK.KKnre : the farmer U dependent upon a 
dinnit iiiiliiHnce ou the innwnlar »truoliire of the ri««els (Kkuws-Swjcaud). Ac- 
conltiig Ut Bkuxton. aitriic of nnijl ticL<; nliw iIJreetl.T iiihjh the smooth muweles of 
the Mtcries. while it lownrs (irt-^riftl pronnnre Uy diniiiiii-him: the re*.i«tuiiiM of the 
circillBtJOQ. After itH inh:d^itiiiii, tli'irti iiiui\i:di:ii.«ilv uri;<f<s an iiit<^Ti)W3 redili^nin^ of 
the face, with n ferlin^r uf |,T«iit hrjit in tiw tnw an.t bead. strmiK injecliou of the 
ooojniiiTciva, increiwe of the puJ-ie c'lJ-Mi) b«jat»). dimioutioii of Unision of the radial 
Bit,, farther ou faiutueaB and (ueliugs of dtxtrvati iu ttio pit of the atuiuauh. 



1. A«.eMIA : IB4.iI.£MlA. 

Iaxul .vn.kmia, or isciLCMiA, h tliat comlitioii in which the iiimntity uf 
UooJ of a i>ortioa of the body, or of oue, or muny pnitst of it, ia cither 
diiaiiii^htNL or h-tw in |>ro[*orttoii U* the bhj^Kl<8ii[)[ily of the nntof the body. 
In the l>EAi) DoiiY an or^in ih (.'hIIihI luia'iiuc if hws hluoit IIdwh from it« 
cut Kiirfiicu, or if f-wer puintri td* lil<«nl hio <ili«erveil anrl the vwteeli* nrt^ 
emptier thna in the noruiiil st»t>-' ; if tlio ot'f^an bjipeArs paler, or, ut Icuat, iit 
deprived of itJi color, for the uonual color of ofgAuy de[i»-'nil» njwii the red- 
jiesH uf liie bloutl and thu proper color of thH orgHus. For tins reasou, too, 
not »H or>;auii, e.tj. pi^^montiKl luii^ hccomi.- pale by aDieniLa. B^Hidi«3, tli*^ 
WEO of aiiMiiiic orgaud is dimiiiLihcnl, their wiiight less, with lens turgor uml 
rcsiatuua*. 



hjr t 



From «xanuiuitinu>i of the de-ul only, it ih not :dways pciwibtfl ia conclade with 
Icty resi»«uUnff tbti bli>i>d-«upplT during life aud befure death : thii is demon- 
■XaA by many olintcal ob5(?rvAttou». as \rell an by experiments ou aoimalx. Thnit 
pjr the latter method. AcKKuavN ( V't'rtA. Arch.. XV., p. -iOl i showed thnt death by 
■ulTutattou tji a]w:ijjt a-s-siiniatud with nmtimia uf the brain, nnd that the oftien {ler- 
cepttl>le hrpci'ii'uiin of the brain in the bodies of thora who had boen MufTocatft<l ia 
aJwuy> the cMnsetjuence of a meobamoal gravitation of the blood, and thus is a 
pheuoucuuu of death. 



TUK CAtJSM or LOt!AL AK.KSitA sometimes appcrtf aXfme, snmetiint'H simiil- 
tMQootialy with other intptii'tftnt coiiditioaA, e&jicci>illy with gciicriil aaa>inia 
{aft<*r liiNK of bloodt etc.) uud wjtb diiuiiiisheii activity of ihu h<Mirt. 

I. ME<*HAXit;AL, or PASaiVK AN.E.UIA nriHCs rno-st often frnni i>rkr>)(tre^ 
which, causK'd .-toiutrtimoH by exti;rnnl, sometiutoH by iiiU;i'iui1 firet^s, affi^cU 
either tJio vrsscLs alto^«ther, osp'sniiilly the ftrtori«;s, or only iho irupillaries 
(pressiinj n[*nii the vr-iua alone cnuHetf veiiouK hyperemia). Anipmia from 
rtrtranurr uii tho surfarr, t'.f/., oticurH from pivKMur^ by articles of clothing, 

ndagi*, «tr. ; in iuU'riml [>artK, from stroiig iiiiist-ular cnutrHprinns, nrcu- 
_ tilatf-'U fl»crL*tion4, di\>pHv, exudations, extravasations, contrartiriiis of 
cicatrice*, nc-w-forimitioiw of i-very kind; in tlie lungs, in inai'ked emphy- 
sema; in thf* int«<Mtini's, iu bi;^b d<-grft> uf lut-imiriKm ; in llm brain, in 
frnotorts of t!ie skul! with drpn^ssion, i.-tc. Th^mi forces are of c-yptri'^ijil 
importance wbcm the orgmi pri'ssi^il upon cannot turn asiile, na iu the closed 
alcull, or when only m trifling av-oidancv In pasttibbj as in the spinal onnal 
ftad in the thorax uf old people. 

3. Anstnhi occiim from coNTOAfrrioy or occlcsion of arteries, tuid 



160 



SPASUODtC i8cnjE\ru. 



thus ia a coiiscfjuencH of arrcstwl blood B»|ip!y : AkTSftlAL isrH.FJiiA. Tbl 
form of ana'Diia ariws, bi-Ruiea, through prt-sHure on urtitritf^, hs|ii*ouiII_v i 
pldceii whiMf Hvoitlance of it is iiiipuHKiblf {r.ff.^ thi' art. ci-un\Us ubove tlti 
pube^T vaviuiih ai-ttricn bonetith tirui fuwiw], tlirongh iHcut-uliuu, lignllou 
luul oblitemtion of Hitoric**, thi'au}(U tMitoi'htliL>tii<.t utid ouibolic Ihroiubi 
through inllHiimiHtiouH, f»liy dogeuurjiuuii, rtc, of tin* nrUiriat wall — e»i 
cmUy if h colhittn'al circiilalioii 4Joc-s uot sustiiiii the blood -supply. 



■t«pe^ 



Ht>ra also in port belong mniiy so-ciUled roL-t-ATEitAL ax.gmIiC Aff., the coll 
otUDinii of tbft bmtn in expaniuon of the urlcriCM of the thrniid fliuid, in portkljrcii 
tho aplftochnio. 

3. iDiorATnrc^or spasmodio AN.KMiA,or isi'ii^mia arim^, sometimes from 
tlin^ft iiiiiueuwa, e.ff. cold, upou the ai-terial muscles thomselvv^, or ujioc 
thu CHpillarius; tiuuietioies tki'ough cuutittclion uf the urteiiul uiu!&de>i ut 
oonHetpieiitx* uf an irritation or oxcitatinn of tlio Byiii|iat1ii-tic. The laLt«r 
oo«:iii-» at the et-iitit? of tho vaao-inocor iioivoh, in thoir course or at tht-ir 
HXtrL'miriiK; it hapiieiis din'ctly. or iti a roflex tuauucr. Horn Itvlon^: 
ODiotious of a dvprusMiig iiaiun;, as t^i-ror, fwu-, grief, e);pi*ctAtion ; exciM 
pajwioiw, US aii^i-r; iiiHiiy ootivulMioiiM, local a^ wull m, gfiicral {'•-//., so-callcJ 
rctlex epihrpHv); the tinit »t;igi* of ague; inoiiy paralvM'Ji (limbs paniJyH.-<l 
for a loug time are luoittly pale, cool, their pi;lKe .srnallttr and less diKtiucii; 
iiuuiy hyjH-nuathtysia! ; electricity; peril iips the hal>ittial u«« of nleohol and 
iiiteiiiperate tubaiuxj smoking (Met: p. Itil); many iiii'(liriitiii;iita, mi^uiii ftir 
ai'iVAt of blood-dow, or styptics, particularly lead, ergut. the liulphates u( 
iron, xiiic, copper, ct^:., p<.-rliap8 ultk> lauitiu uud ih? uiiiiei-al acids; some 
uarcoticM, to wit^ upiutn^ digilalia. 

llKows-SiUjnAnp Srat demtrnvtrated. that by oleetrio irritation of the synipi- 
thetjo. comlitioas oppoisitc to Uioae caoscd by its divtiion occarrctl. but more iiloiriy : 
namely, uoutrnctioii of the Teuals, paltmew and lowering of the i«uii>erature of 
Ibe part. 

Atbiokkb (I c.) olHtervPil the aliuotit entire eltnure of many capillaries (perhatv 
only young oumI after chetnioal aud elnntrical i^"r,...'.,.j Th« oontraotcd capil- 
larieb w«?re ho pole, their goiiLoiiT") ao illileljiie 1 ^ cimld hnnlly be di«tin- 

^ishnl Ipjiu tht! ^n^rolln^liD^(■ li^Mnc. Thi» i» in , i of the nerve* Similar 

conditioiiR oncur prolniibly duriug tlie a(:ti4in of niauy [h>u«(i-j'<4, in jtmcou^ nipmbmuta 
bronifht in uotilact with the poiKon. Au alf<*{.-tion of the re-tijpbagun resulting (mm 
tho action of c.vtxtio alkalies, bouu by mysflf, sujiporw ihis. ^>'aubU, Arek. d. 

UrUk., xin.. p, ail.) 

Among ibu iutHli«)mi>nt» referred to. Some espeuioUy ore freqnontly (Employed to 
induct: louiU or gHimnil iviia-mia. Tu the f'inuui bclouj; Lliu eo-caJlL'd MyiitjiM ; to ih« 
laLTor. >>i!iptr*;ial!y er^oL (hoc p. IH'ii and dig^italia The htlltir. Afleriuji^cticai uf >trouf 
dmieii, c^im^oii n ooniractinn nf KtiirUt nrh>riM, eg. of Mw mettimtory, eren oomplot4 
tenure of ^orae. and Ihen-by an ini.*n.-ai«e of arterial blood prunutre. 

AoounUngloDuiujlH RKvmKNU yAitli./. Annt . ti, ». ifl., IMIO, p 401 1. those OMM 
of migraine in ivbicb Lhti iiffecti-d b:ilf of the head ih|Kile, ete.. depund npuu atatanos 
of the mo^clcHof the veK^els of thu pnrt, wi-callRil heiuienmia Hyiuiiat-hico-tonica. 
With the obstemeot of imiii thi.- .ilTL-'ai!*! (.'ar mlduiv-H aii'l (Mjcomca subjectively and 
obJACtively wanner, in conaefpience of the ffttiffue of the arterial muftclcs. 

TKAtrttH {JK Kfin., 14t>4. Nr. 17f accounts for all febrile phouoniooa. by affiramiog 
a tetaiiuu of the nm;dl arlcriBtt, oUietiy uf the luunli veasels of the body, abaoduitJy 
provided wiUimmHila-fibrofL (See FKVBtt.) 

Along with aiia^mia of one part of the body, (liere is always found hy|»(»r- 
(eniiiiof one oi* moru other parts: uoi,i.ATr.BALorcoMi'E.NsAT».iit\ uyi'^iukuia. 
CollattTAl hypenetuia occui-« sotijetiuica oiily in the iniMieiUdte ueij^hboi^ 
hond of anaemic jiartA (tht?! nu-call('d hypcmrnic ai-ea around intUiuitiuitory or 
exadatiou area, oud new-foriuatiuDs)j sometimes at a greater dititiuicu fruta 



4 
4 




LOCAL SYMPTOMS OF ISCEI^^riA. 



167 



lobes of the hi 



of the 



1 1ty[H;ricmiA of the uftpor iohes ol the lun^^, m aiKPuim 
presann?, etc, ; liyperivniia of the brain, luuga, otc, in anicuiia of 
the pxtnjtuitieK. 8otiirtiiiK>a it atf(>ct8 the Mime orgitn, (xtrts of whicli lu-e 
uiwmic ; Aoiui'times it ulfocU orguiiH at a diNtaiicK («.//., in tbe ttctioii of 
iot«Ufeit cold, ill the cottl e>C-ngu of ague). Its uxteusion is quite the trnuiv us 
tluU uf uiijvuiiit if tti»t of the litttur is suiall, bo also for the most pnrt is tlint 
of thfi former; if AUieinia Hlfi'ct the* whole skin, or a lixvge jioi'tiou of lliu 
iuti.'stijioH, hyporiuuiiu ohm can art<.^t many iiit^inial orghiis. rVilluti'-rHl 
liyiK-is'tuia is soiLn-tiiueh arterial, whfu arterial bloud flinvs out of th« 
VfcSMels in tlio vicinity of the uiuiMiiic ^«irl inio ihti latUir ; soiuetinn's vwiohh, 
whou vcnuuH blood piiiirK into t\n: ciii[>ty cniitllarit'vt uiid vuiitx^ lN;biliiI tho 
uoiurnctcU artcrii^ the lut<>rul |u'<;>wure bt'tug diminished. 1'otlati:ru1 
hy|K>]ii>miii wiuetimes lasls long, somf times it [nis5«s away quickly, when 
thfi blood is not luUii i"<*t'Unod in the vicinity of the nnieniic part, but is 
quickly dihtributeU in thf j^cnoi'al hu(iioi*s. 

The 8YMITOM8 OF AN.EMIA aie fALENEsa, UiWKIt TEMPEttATrKB, aiul 

niHiM^HKit n/stTioN of the iwrts atffcted. They ai-« yxplixined, [Kirtly by 

tliR diminished quantity of blood, partly by r^t.u.r'laiioti of the bloiKl-cunvnt. 

"Jbcse liriuptonif) are kitown with certAinly, c^spocially in oxttirnal part*, 

cially the skin, iu tho muscles, in thr [peripheric and central uervous 

lu. Be&idnit, they vary gi^nttly, according to the dogrue of the ainvuii», 

itii cxten^on, luul, at lim»t in sonic oi%,'au» (CMiK-cially the brain), according 

LJttritK origin ; also its seat uud extent of the collatcnd liyperuimia, etc. 

^K>[ I Vtrrh. Arrk, 1800. XLV.. p 417) baa experimentally, and in inirfrioal 

^■k^ .\X^(\ the inllueni^ cf iliatant Ij^tion of tnidn arterial briuittbuit a}>uu tbu 

^n-i'--i'^ "'--J'-' oftptllnry ami vuuoub circulaticiu. iVft«r li^atioa of tor^ bualtliy 
»rtcri(.*i> ibt; eitculutiuri » tLm:«t«.-d utily wbi-'ni Lliirti in prusnnt no art«niU pomaipa 
frtf tiip IiI'nkI timiltitiini. Ill all ('thor caapfl tbo circulation roraains uninterrupted, 
with the only otfoct of diiaiiiiithing for a ohart time the quantity of binnd. and ihe 
rapidity of itn ofrouUtion. The pbcnomcoa of tt^uin are very markcH) oDly in the 
fint o-iM, and ap]w:ur la warin-bloodod anniiiU-i in tnucb sinnllor proportion, on account 
of th» very kiuuU chaiiuulti ihrou^fh which n'g-urj^ntntioii in pc«siblo, iiiuc« th« Uri^er 
r*fn« :jr« pruviiNwI vriiJi valvi?»i. 

Ain'Midin^ to hwioTTI [ VirfA. Arrh.. h.. p. .'ii*2l, the cirrulatiun m thw web-mem- 
brain? is r<:lanimi aftt-r clc-mro of the feniorol art^^ry; neiUier in tb« arteries, uor in 
< the Mina iitl- the coDtraJ columii cf hlo(N}-corpiihole<t and tbc peripheric si-ioud zone to 
I be di>tinguisihed ; rather, the chmrnel -"if the vc*>«tcU \n uniformly tilled by a mft«» which 
cuD»i»iA of iftiilalcd bluiMJ-globtileH tlniitiii^ in HHnnn, The channel h, tilled full in tlie 
ta|)t llitr i«'* »n<l tfiaall vvius, and ilii; retardn;iiin of tho circiilatJun iu thrni ix );ri!Uter 
i.ir^ reweU ; sometiuies the bluud muii'eH with cKtretiK Hlug^irishaeHA ; tho 
tare not present. Thu circubLtion ^radtmlly heooinea quicker iifroiu. 
u,...i ^ .. ■' .1 reatoied to its normal cotidiliou 11(1 huut« aftor li^tioa Imtatiou of 
th*.' woh UK-inhmu*: htrw acta just an in thu opcu [eintind artwry. 
I^ijiiu-ult iUfco SvMl'Kl. ( VirrJc .Xrch., h\.. p -11) on tb« ijiUuenoo of ligation of 
^^K at Iwriea uiMU the nriffin and »iQr!i<> of (fan^^ue and inllammation. 
^^H. NAtWK {I'aUrs. (Jfi '/if KinJiiiMA, itfJ'-fif <iu! Lt/>n{i/thiUtttHg hfherrafhen^ lfl7l) 
Hm^ mi x^fitpxam of the lympb-curreut('i}-10 jHTwiit.) nft^r liRiihim of the atroddi 
The WAtery oontcata iocieaM with the decrcatte in the quantity of Ijroiph. 

^Brho OUBATiuN of A>'j«MtA is, BccorUiug to its cause, sometimcH short, 
^Stm^j; RT'condft .and niinutea, anmetimo^ longer. T'tmn this depond in 
j»r^'at j.art the resulta. They are as various iu short duration, as the organs 
(the akin contrasting with the brain). In longer duratlou, on the cou- 
tmry, or in complet-« amvmia iippearing sudtlenly, tbo nutrition of the part 
ia te5?i(-'nnd, even when the unnuiiia allVcta the ve^Keln only with respect to 
their function ; it gives rise to atrophy of varions forin.s, oven gangrene. 
In AS£MiA or THe SKix, it up[)ears white or faded, which in the absence 



ICS 



I8CII.EmA OF TUE SKIN AND UCSCLES. 



of otiicr aViiioriniil coloriii;^;^ of tho »kiii is c^i'tainly striking; it appoart U 
liave liMtuomewhat in V()luiiu>(unlc&fl (N>ni|ilic)itioiiH, as dropHV, bavo AritHUi). 
The Kick [lei'Hun, em well as tUu [ihvHician, (aeU the akin to be coldrr. iLi 
Becivtiun it diiniiiit^iiRil ; ii is tiry und, for tlie most ]mrt, witiioiil liistn!. 
ANiBMIA OF TIIR I'L'TANEnt'fl KERVRS lA maniftjHted Uv (llniinihluHl ftinciioDit 
of those nerves : pule, p.,'/., cIiiIUhI (wrts r>f the skin foei haiiJer, or give the 
subjei'tivo feeling of iiutubneoa. OiM'rutious on such parts are letss painful 
(iio-o.illed local unoittthesia), 

AiuimU of the skio i<i Ahown mt^t clearly daring the acti'ou of low temperataret 
{ait at wuler} ^cbn Hkm a;>!>eAni p^de, hat ftmii \oug iluratiau of cold it becomes Uofi. 
The latter nmeit fnim lltu fact Lh.it by Lb<* rutardatina at tba blood-oturent t-bo 
blood -ooriJinxilt-H tnke up more oarbuntc naid thun nririnaL 

According to At.t^uKKU {M-trff. iJUs., l'S)3), atuemin [and h.rper.-Qtiim> nf the «kin u 
ftttendtiJ by a dhjiinishod sense of dUtance. The sftrL^c of temperature i» blunted by 
liTp«r»!imia. iBK^niiLvl by uiuv uia. If tbo fiu^rcr la held for n Ujti/ time in tce-watei, 
WBll-kuowii HbarpiniiiH rnMiiU. If, oti t*m othor liiuid, it la held hi ould nlcuimt. ev«a 
of — r» (J., no yaia U fi?It. while the touch is atill FeCained. Olycorine act* in » 
Bimilui HiaunQf. while e&l)«r gives rise to the same paius as ioe-wat«r. This phv^io- 
logicaWy importiuiL fact of au artlfiuLal sepamliou of the ^enac of tou><h from tlie 
feeling uf pain, la aluo of ralue aurK^all/ iU>nvATa, .\ff'l (.^tribl.^ 1K7S. Nr. U). 

NoTilS'.\()R). (D. Areh. f. ii. jitril . IS(! t, If . p. I7;{; doHcribes a ueurowia of Die 
han<lH anil fnrft-annt dependent on art'^rin^l ernmp. which oonaixtod in a feeling of 
ntunbni'as nud ting'ltni; or cnittini* pjunii, nlnrayn With a dtsni^roeabie 5a)i4<) of cold, 
with dimimshed u-u6«: ol' touch, tuid little or no di&turbanco of motility. The Qngvn 
and hauda were pale, aui from ^3 C. catd«r The pheuumona w«ro siimotimei 
tnoat marked in the mominc; after riRin^f. Warmth nm lerated theiu ; Itkeiri^ve irri* 
lantfl to the skin (rubbmj;, but eKpeeially the onnaijuil curront). Not infrequently 
aimilar and Hometlmoii paiuful cram])« alTect amaUer lucoliticA. f.g , the endit of ttM 
fii^rers, litnitAd poniauA of oue or nimiy ttmon. They arUc i)uickly, and diaaiipear 
qniukly, or, for the motit ixkct, eJuwly, theii' duraliuu iiuLin^ HumeUmei wcoks and 
nioatba. 



AST.MIA OF THE voi.nsTARV MtTSii.KS, of sHglit ihigree, is known by dimin- 
iahod coutructility, stiffness and numbness; if the auaitula i» in high Je^ee 
und arises suddenly, it is folUiwetl by complete paralvKia of the iQUiicles 
(jiiat HK iti the lowfi- Imlf of tlie body ufler ligation nf tlie abdouiinal luirta. 
in the Hxtivmitien after li^ition of dilTurtrnt arteries), 

AeoordinjF to KCUMi l KOiu'snh. ZtxrJtr., l8fi7K the affactod raoaclaa. la compres- 
sion of the abdommv.! aorta, remain a lon^ time ttonapareat. if cbey tiav-< lo^t nUo 
tlwir power of coutniL-ttou ; the latter retumi with the return of t)i on. 

If the muBuIa •wilwl.'iiK'e itt cloudei) (true ffM i»/trfi:m rigiilitr', their in •■og 

not return after reniov.il of the ligiiMire. U;)S«ntiivi. ( Wi"-". mrt. .I'.-ifi , i«;3, 
p. 4rH> found the etcL-tra-musoalar contractility deiitroyed, about two hount after 
dofluio of the tliao and femoral arc«ri«a. ^Vftcr temoral of the oVtsLruetiou, OOO- 
tractility waa nfraduully rvstorud. 

TliH phenomena of jiN.KUiA of ths »u8ulb or thx nsaitT *ro as yet 
but little known. 

BczoLl) (Jtf«rf. Ctrlht., l**)?, Nr. 23} closed with foreept the coronary orterlM of 
the haurt, after previoiu lUHitiua of the o. va;^. cerviual Hrm pathetics, and the cervical 
{Kirtiou of the conl. After ir^-ITi ttecoad!« the hoart-beata booame les* fre«]uent, 
after ^-| minutes irreyulur, after I -I J mJnut'Hi the v^entricle^ wore c >mp|etelj' re* 
laxed. After romoral ot the obstruction, ths ptild:ttit>uB ba^aa a^puti an.l aooa 
became perfectly regular. 

As.cuiA OF SMOOTH jfrscic-piBRe^ has as yet burdly beoa cousidored. 







ISCIT^EStlA (IF THK BRAJX. 



160 



Accordtn; to 0#er and Sculesisoek (.V*i. WWW.. 1871, Kr. 53. 0>*tr. Juhrh., 
1-STd. p 57 1. irrit'itWH of the ceotril uervomt systoia tliroui(h iatetruptiyu of Ihe 
reftpUatioo, tbtvti^li acute aiue nin. or tlirouijb iuternijitiou of tho arturinl lilood- 
sapjil/, gives r;iia oftflr a law (10-30. or 80-120) iHMiomla, to a ifi-nfral C(mtrut;tion 
of lite aloni« (uat ini[)rc;;nntu<]|. Tho irritrktion it commiinicatu'l thriiugh the 
' )^|tnn.l «oni (Thu bloi>i nf «uffij?jiti*»n. if it \itv* iUt orijfin in nnspHUHlim nf th«s 
toqitroCion or comprenuon o/ tbe iiorta. likewise ^rea ri»e. only later, to a general 
iiwrin« movemeut) 

As-EMiA OF THK RKAis, ill iM Ui^hrst ^iwliw, if j;oiH*niI ill rxti-nt »nil of 
verr quick origin, fk.s fr'Jin ligation of all fotir of the cerebnil arteries, is 
fuUowcd by InKa of cousctoasufss, of voluntary movemeut, of sonsibilitjr 
U> irritants, by rutArdiittuii uf lliu rvspirntiun, by accvlci-atiuii of ttm {lulue, 
(lUiit4ttum of tbe i>ti|iilH, oonvuUiunit, — tbita reiK'iiibliii)f lui iittnck of epi- 
Irpsy or eclampsia. LighUn- ^railcs of ur*uL*i-a1 ceiobrol nnwmia wvo proba- 
bly, for tbe raoat jmrt, the niuw's of fainting fits, wliiuli atfecl Ibose wbo 
ul Uetin very Kick or are convalescent, (luring \\iviiv ftforU l-u hit ii]i in 

1, st&iiO up, utc Afttir ligulioii of one cumliil, or after totu) i;iuboIi»ni 
irf it or of an art. ft^nr Si/hii^ there oftmi urisps Knrlilnn pantlysis of tbe 
opposite* half of ibe body. Tu tlie less sudden npiieariuicc of Rnit'niia, imd 
ill individuals of tliffei'eut atc^s, tbe syniptnius ditfer and its dio^^nobis from 
liy]H^r:nmin oftA*!! Ix^ooincH ilillieiilt. .'VtiinniiA nf single pnrtH of tbn iiUMlnlla 
oblon^Lrt is of e^iwitial impurtance, iHfcaiise of tliH nmny uraniHl ii«^rvo8 
which arise therofroui, uspL-tiiully tb<; vagi, and bocauss of tbf* intluence of 
thfsso nerves on crtrdiac and respinttory movement*. SomHiintfs unieinia 
of strimratu parts of tbo brain, and byiH^nemia of other pmta (not merely 
4if tU(>Ht> in the iinn)odiat« iieigbborhood of tho»9 airL'0to4l by the former), 
occur at tbn same timo and givo riKR to the most complex syuij>touiatology> 
particularly that of pressure simnltJiut^ouHly with that of irritation, 
Anisniia uf the brain HubstAnce and Hintilnr nJfoctious of the meninges 
cannot bn (topiiratud. Amcmia of tbu iiienibranes and of moat extorDal 
parts of tlie brain ore, usually, simuttuooous. 

The ftocalemtion of the pultw* (A. Cooprr^, folIoMrtn)? oUwure of the ciirotida. de- 
pends, a<coordin(,' to Mossii ( fJ" tinpnn. IST^. XII.. Nr 17). iipnn an irritntinn in 
pirt of the Tftjwmotor nerves, in part upon that of the nerv*^ wliioh presidi? orer 
th« accelttrati/in of tho pnU« The aniHmlft Aae.t not act as the irrit:mt. hut the 
ahttrmoH nf the irirrulntinn. M fmind, thii.t, cliMuro of the common carotiiln Axerted 
a lo« iat<>ase «SecL tbim that of the interuri! caroti'l ; also that after coinprc^tinn 
of tb« oommoa carotids the blood changes its direction in tbe iiiterual carotid, nod 
flow^ into the extemoJ oarotiiL 

KC'^AMAii. nnil Tkxskr (l^oitxehotC* (htt'.rit. «. y-itarL, 1857. III., It. by a NOnea 
of experiinectct on nhbita, with re^nl to the ori^pn and nainre of epil<>ptoid cou- 
TuUonii in hnniorrha^e, as well an of epilepftj' in ]>iLrtiniiIar, ol>r.ain<!d iiuport-uit 
r«MiltB. Convulsion^, whirh apjiear from biemoirhnge in wann-hIoo<lKd auniiRli! and 
man, rcnerahle those ubocrved iu epilepsy. Similar eouvubtions appo.ir, if the braiu 
haa •uddcidy bu«a tohfawl of ttn c<--d lilood. as by ligature of the (preat arteries of the 
neck |Alw>, when arterial hloml quinklj aixmnefl the cbaroctor of veaoun, as by 
lifktnre of th(t trachea I Prnhabl7 the appR:iratifle uf canvuliuouH iu thi^e cjuraa 
de)>eniU apon the suddenly intpmifit'jd nutrition of tJui br-iiu (luit upon *?baiigad 
oonditioni of preseore. to wliich tin; hriin is auhjectojl). Kpileprid ninviiUinns have 
their central focua in iJio excitable rojfiDUB of the brain, whieh lie iiKiirNii TtiK optic 
TnAL4Mt. Anmmia of thn puf of the brain lying anterior to the omra. Kivea 
lins in man to lam of cnn!wionnn«.<i<i. ianennihility iind [lamlyniH. The bliio<l of thd 
cranial cavity U ffreatcr In >]itantity after li^nture of the arterina than after bleetHiig; 
the want of blood alvrujs alTix^ts fspcciall.T the mnalt art-eries, nnpillaricn and AmuIIenb 
vpinm, [See K. anil T. tin KinL-jtfifi^rm fohruUin/ut ffom IJiKftturrhnge, Now Syd. 
Boc Tmna. Lond. 1H*»0.— Eo.] 

Aooonling to 6i-iiitltz (Pt-Uirth mni Zt»r';r , lft70. I. Tt,, p. M). the irisand fiannro 
of tha llda at fine oootraot after ligature of the carotid and vertebral arteries ■, tho 



isonxiax or the bbaiet, eto. 



'li<\% close «paiimodiir.tt1Iy : the anlraalu are iincoiusclnus ami ithow no r«actimi to 
cxtcniftl imtanta; the eje-baUs ure drawn Ikm-Jc iu Un? orbiLs, mul tnm«d apwarO 
and oiitwftnl ; respiration is aoccleratwi. Aft«r 10--*0 minute* (?(, the respintoi? 
Tnnv-nifiilA lict.iimu slower, the oerYical inasolcB tuo puml.rzcd. tbu head ilrup* u|kiu 
tbe tirwiMt, rli« aiiiiiifti Iwndsi over, the pai>il9 diluto. ond tlif eyns heoome jjfoiiiinont. 
Then totiic colltmctIo^^ of the uvrviual mtuwIcK and (ri^numl caiival»ioii.<; appear. 
Tbe extivmltii.tK contract in clonic form; then the cunvulHions he(»mu nit>n.* tuCamc, 
tuid fiii'illy disitpjM'ur alcn;rether, Thi-se ]i.ttAck.s la*t f-2 minntc*. After » *hori 
|mu«(.\ ibeii U-yiiis a BCC-iUDd, nnd thini litt-ack, but alwajB weaJter and shorter than 
lieforo. If tho ligature be romovod. rcspimuoii quiokeiu, and oousciouaiiow r«tanu. 
MiorMcoptual uxainiuatiun, if carutid« aud vcrlcbnUd are tdinultaottODBl/ Ugated, 
Bhowe n difit^not |>.il«.'iie>^ of the cerubrul vc:*m-.1m, a di>itiiiL-t inovemeiit of the blocxl- 
corjxiKltM in tbe Hmall art^riiiK, the blciod-rouvement appenm in th« vuioK, thf tnoNi of 
blood -corpnscled Iomb in lU-nsit^*. 

NoTiiNAnr-.i. {l c). Iroiti cxperiiuoots. by which he obserred the TCMda of the 
ina-maiMit thruu^jh a trophinc-bole iti the akutl. thinlcs that many aptleptio attaoki 
liATCi ilieir rihgiii in n rellex contraottan of the cerebral Tcssfthiiwith thriw the Twinli 
of the pia have a common origin) ia 0(mrf«()uenc« of irritnlion of periplierio MIIH17 
nerves. Miiiiy caaM of so-called r«ll«x epllepii-y i«.«tJ(y t*) tliis. (Se« p. Ui'i.) 

The idgTiK of HO-culled compression of ttie brain, besides whiuh Lliere often exiiit 
at tliu Miiiiv tinic outicturiiim and c>uutuM>iu (in cuiiHui^ueucti of froctui-es of tliu skaU 
with dupn>»^in[i. hu^inorrhngc, etc ). arc. in gciR-rul, losa of cotiKciouKQeMi, >loeptneai 
^or rtojior. cxmia, stupor, etc. 1, normul ctinliuc and rtupiratory inoTcromM or rptanla- 
tiou of boUi. ttc. Accirdinu tor.\<;KN.TrKfilEit. a prrwiarc npon the bruin, fiuffit-it^nt 
to deitLruy life, mu^tnmoimt to about IH(> mm qnickflilver. and thii.i equul tlie blwHl- 
preiuinr« In the cnroudH. Consult lext-boolu on sttrgery. Abio the ex)»erim»nital 
invoatigationii of nKriEt^fAYKR. Dif AtJtf"if>tirpi/tniff'ii Mm Uirmtruek. Tttb. Dial, 
1»:>9. Lkvdks, Virfh. ArrJt.. I8(i5. XXXVII.. p 51J». Jol.LV, CnUrt. ub. d. 
GfAirmtr'ti'K- u. Utirr tlif IHuthexregnn'j im SfMiUi, \Vi\rzbarg, 1871. PahexsTECUXK, 
JExptr. n. Shuitrn iibfr Oehirnrfrtiek, Heidelberg. Iy71. 

SrntPP''fi dxperiinunt dcinfiniitmte>i tho croB»Kl oouduclion of wnflAtiona. Thtrir^ 
Compn'JMioti uf tbe uarulidti uivu- Lhti biryux, thcrv ap|Hiar furiiiicatian, tdight feeling 
of warmth iu the extremities, and half of tbe head of tbe other Bide. l>arin]f com- 
prcsmon of longer duration, there arlMJM decrease of aenaibillty to pain and prcsanra 
in the part'* of tJie oppuedtc half uf tbe body. 

Acciinliiijf to Dl'RUAM ( Guy'a limp, iit^i,. ISOO, VI.. p. 141*1. anorinta of thf» bmin is 
the nrinii.il cunditton iu xl'.'L'p. This is «hown by examination of tho brain tbroD^ ■ 
hole ill the sli'iill made by a trephltir, durini^ .'ilrit^p frnm i^hloroforTD ; a8 ^Outi as tho 
HDimal awakt-a. the surfai.-e of tiio brain rnd leuB and bulgt-s out of tbo orauini op«m- 
lag. Auoordiup to OuKit-^TEiSEn {AII3. ZiscJtr./. I\vcK . 1H73, XXIX.. p. 23li, the 
ttccumulatiuu uf acidit ansiotf from Eitti^iut; activity in nenru- iFrNKEi aud hrain 
fElEinuMiAiN) oauiieii fatigfue of the bniiu and aleep : oiid indeed anieiuia nuu like 
hyj>era>:utiL. eto, ^CoaBult, W. A. LlAUMuNn, SUrp unil iti J/eiutugantJtf*, Phila., 
IWH.— Eu.J 

As'.EMiA OP Till: snifAL CORD giv»t rise to pni'alvMis of HPii&aUnu aud 
motinii nf all tliH nerves of the exd-eraities given off holow iho pflrC 
atToctcxl (most Bti-cjilIeU paruplegiii'), ulao of thotw of the trunk, i-espii'atory 
■uusi'Imn. lilmlilcr, and voiitiiictiuu uf ttit; |iu[iilHj accurJiiijj tu the extUDt of 
tho tttiipiuia. 

IdciLEMit? TARAXYSES are those iu which the motor ntfection of innerva^ 
lion in iloiiciiihrnt 011 a cuttir)}^ ulf of th« arterial bluud Hiippljr in cortailX 
pat-t8 of th« ucrvous 8;^'st«m. 

Str:40N ainuuly iu 1007 damanntrated the «ame faofc, byooraprOMtlnfr or lifrodnir 
th« alxIomiii'iJ a^irta iu riibbita. beiivath the point at which the renal arturii^t ore 
g-iven otf: after a few m\Diite« there appearoil complote paralyNui of the hind 
extromitien, wliich in comprevnion of Hbort durntloii. aft«r » nhort titui.-. ii{raiii puM^s 
away. Tho paralysis did nut priKieed from tliu uinxolct*. ait Stem iS and othrrHbrrliw^ed, 
but frnm exporiiuouts by LojfCET. Kt-iiipp, 3ciiiPFi-,u, kt<;., it ha* iu- fouiulatiuu in 
tbe arrcHbtxl excitability of the spinal cord and pi-riphpric ncn'Ce : closure of the wpinal 
brauoht« of the lumbar arterioji, entering throu^'h tho intcrvcru-)>riU foramina, ia 
follow^ed by au amumia of the q^iiuil oortl^ probably cbiuUy of Iha gray HubntaDoa. 



1 
I 



GKyERAL STSirroMfi OF ISC1I.EM1A. 



171 



EtiR«MAri. {Sftl. JWin. We/inteftr., IS72, Nr. :I7) found iu a com of tto-cnlled 
tetau;r <CoRvtKAnT'a), wltiuti woa chnmotcrutod hy aiUuika uf louiu nonviilRjonk of 
miMij *jrmiiPtriiyil iniiwl<?i£ of all foiir extr»;initiej*. tlie fiti*" tietttrminwl by TlnU'S- 
6EAt'. llutt, to wit. in the iiittirni<!tiiute iinrus free frum uoiiviiltiiuiu. coo\uiHitiufi 
Bpltcor a» Miua aa pccature la exurud upuu Llie |>tiDcipiU iirtury of the muiiiber. 

Tlit^ Hf^rotjon of olandi'Lah oiiganr is diininished in coiiKequeiice uf 
ANJ&HIA, aud prubiihly uIhd cliun^ed. 

Ill tlie KIDNEYS thei-ti ari>ves, c.//., in iucompleto filling of tito \*fTt miIb of 
tlie hfnti't and iiicnui|dt'U! tilling of the r**iiA) ni-terii'R, a diiiuimtion in the 
qnnniity of the nnn<>; the nrinu in deticioiit in water, concent ruttil, iJitrk, 
urati^ c*asily precipitate iu it, becauRC tht*y are relatively increiiMMl. The 
Rnnii- thing 18 ohscrvct] whi'n a hirge •piantity uf water i» excivted through 
tlif Kkin (in great. HWHHtit). In the liver, the Hu^tarntiun of bilt? is diuiin- 
ishe«l after rlosnre of the (Mortal vein; and yet it btdps coniple.Urly if the 
hepatic arteries ali«o aiv obslruet4'{). A diiuiiiution of scciTtion hIho occurs 
in luupmia of tho auxuva of tue MCiHius uemhuakes. 

Tliut Iix-al auwmta diiniiiifheii tlie secretion of bile, in ■hotvii hy tliu experimeDta 
of HKridCNiiAts 'lii.'iziiiijf i]>'.r (!('fiiHsii*;rT«'U(. Pj-LPoF.n idirccto electhsche Ittilzuug 
dcr LflixTj, oaJ RaSK»: i,gcst«igen€ ArbuiLAlviKtuug- <l«r Korpenuiiftculatur). 

Conccniing AX.KMU l>P TUR VSaSEL-MTALL, Mse Umboliiim. 

General phknoueka. in consequence of ona'miA, occur only when the 
lBtt«r is very exUiuded {p.//., in coiiimou eoIdneBM, as after marked and 
Budften cooling of the burfaee of the lK»dy, and in intermittent fevi«r, where 
aiuemiii alTeeta the whole skin), or when imiHirtant uerve-ccutrt'a are the 
seat t>f aun>uiia, etc. Genural phitnumena then have their foundation iu 
cotupen.-yitory hyjwneinia of other important onfans, especially of the brain 
Mid Uin^*, or in changes in ilie heart's action, biuoil-presanre, etc. 

The ffoacral oonseqaencea of Irritation of the Rj^lanchnfo nerreii are, phjsi -logicalty, 
kuoHrD witli oertAiiity. After irritation uf tbc cut iiplanduiic' nerve, thuro ariw!8 an 
A^.EMIA or THK Ani>oviix,\i. vi:ssKi.> (since evwry icnif!'':nlar tiiuv»ai4.'iii,. uvi-n,- innpi- 
ration diininifih«s thfiir cmitcntR), aiifJ oonwdnrable INf;aKA8E of ULix»i>*i*KK8.snHK. 
By imt(.iionof the iK-ripIiericpxtrtniitr of tlie splanchnic, the PLn,SEbeconn;afii,owcu; 
by irnuition of the central end. the pnleo ut mostly accelerated. With re).pi;«:( to 
thesv frxp(rniut.'ut« we hare only uulut<:d puthutog^ical cxamplcM : best known ig the 
lar^' auil ^low pul»e in many cramped kIjiUi-s of Hunio uUlotiiinal orgntui. 

LigaCurt! of the oarotidA cnniuiA an incrcnAn nf Ijlnnd-prf^fMure, and, in roiiBetjui'Uce 
of tbc c<ir<Ttiral anremia, an incrpase in nmnher of hRort-hf^ta. M(tP*> foimd. iLnt 
iaerfiaw of hlood-prciwure followiug cIo«ure of a carotid is to that fnllowi%' eloHiiro 
of biitli itiaca OH 4 :1. Hen.- thi.> cam.' of thi' tracing, steep and Biiddt-n, kupt ul im 
almoHt espial htdght, anil, with thf removal of th« litp»tiire. undilcnly r>.-lurin.'d ^^ the 
nomal xtale ; then it wan irn>g^n)nr. and Intr. f^nulnally dtnappi^irfd. A KTcater 
fraqaency nf pulse occurs aIao from like oauKcx. in the chan(,'o from a horizontal 
to D Vertical iMisition (Manyeua7.ZA. Ontz. meit. iful. lxnnl>.. \titiS. pp. ■')^IT. 3tl'3). 

BIixmI |'tt--*»ure riaea, by irritation of tb*; spinal ourd &ud eoni»eeutivi: cotitraction 
of aliuiHst all thi; Mniall art«rif;8 of the body, with or without, destruction of almost 
all the cardiac nerves. 

s. /^rK-.w ,/rjwAr. / rnt. Med., 18«X XVU . p. 120) found a lowering of the 
U- of the l>ndy and a diminutiou of cxuteled carbaaio acid iu rabbiu, 

n 1 iiiual aorta be hod uoinprcHsoI. 

K-kJSTiNo duriuK the prwunca of PLEramc excdations is. acctmlio; to 
Tnt'iiTA'ii'.ArT. deijendimt upon diMplaoemoal of the baart from its nilural po«ition, 
anu ' iltin^ tontion of the f^^ac venmlii coDnectod with it, Mpocinlly \\\n aorta. 

11 ^'■f^.f. ifUn. Mefl. IV.. p. 908) teeka bU explanation in thm: thtt Inrg'j 

Tt-i.-...- ...uks, and cspeeifljly tlie vena cava asccudens, anffer, by tbu b4:art'sdlB- 
placfiiuwut, an almost ri;;ht-MEi<.'iilar hendiufr, wbuni the euvii piuo^^'M throu^'h tho 
niiiliiirt t>*r(tloa uf the tlinphra^m to nnter the pericardium, and where it is tirmly 
attached to the burdtfrd of the quadrilateral foramen. 



inTESjCOOA. 



2. irypKR.«MiA. 

T^i-AL HYPER.EMIA U tbo term applieil to the incre&w of the blood rail- 
tained in more or less iHUimI ami. fur (lit> most jmrt, also lengtlieiietl vess^U 
of an or<;ritn or of a pnrt of the* boilv, so t^iat the normal lluoCuaUoos of 
thn c|uaiir.ity nf hlood aro exoemletl. 

Jiocal liyT>um(mia is (ictivo or pasjtivo. Tliosc hy{ierf»mi» are railed 
Active which appi'^r iu c(in-sm{uuiic« of relaxation of ilie vesaets, so that 
tiie usual lilond-prt'Shtiit) aloiiL* iiiusus a more excesNive fiUiiig of tlimu. Ou 
this aocount, thit form of b\']><;'itumia is known oltio as atomc. rklaxativb, 
PARALYTIL', or, becHune it Diotit oftvn act-n uik>u the arturlra, arteriai. 
Kiiially, of ei)ual HigiiiKcance la tb^ name tK^icnESTiON, etc. Thoae bypenv" 
miitt are calli^d passive, whose jirincipal cause is tbo increase of r(ai»tAnc»w ; 
ainoft here a niochauical force is oft^n inter[>oiHMl, it ia also callod UEfiiAX- 
ICAL, or, sintu; tJiia force most oft*n Hea in the vtiua, vknops. In both 
foriiia of hyponHmia thei-w is preaont a dilatation of the finer vBssela ; this 
dibitalion Ls primary in activo liy]>nni>mi>L, in tli<^ [uissivo form, ac-cuudary. 

CoiJ.ATRItAL, OH fOME'KNSATOHV IIYI'EK.EHIA Ls almOSt alwayS nCtlVt* or 

congflstivf, and occ^urs only with pai-tial anrotnia. It occurs, if the Idood, 
ari'eated in its course by an ob»triiction, e.ff., by ligature, etc, ae^ks* ittber, 
noftf or distant cbannela. (Soa p. 166.) 

How different aativ^ and |iat^iirp hypensmiie are. aooording* to cnniin. aymp- 
tomft. etc., is bwt observed att they affect n tinglo orfton, f.g., the kidneys. Am^'B 
lii^!4Ai. UYPmt.VHiA afiscs from cxceMvc tUlioff of the v&acalar aysiitm. ns aita 
BliumliLnl drinks ; from hy|>ertro}>h.v of the- luft vtiiitricle ; from tb« am of diiirvlica; 
fmm compreKHJciii. etc., »f the nlKloiiniial aort* below thn renal arteripn. al»} from 
obstruutiun u> the circulatiuti in th« capUlurics of the vkiii in the cold td-n^ of rari- 
om diaea«es (so-oaUod coLLATK&ii. hypani^iaiaj. etc In all thoM caitea th« hyper- 
smia offccta obictly thuso parts uf the kidneyn whose blood bos to ovcrtoiue the 
gioatcr resiataitcR in tho. nrtt-rirs whk'li sapply tbo M^djii^hinn botlieii. The chief 
ayuiptom l» an incrcuwjd secn:tion nf nriiw ; th*- uciuu is mon; dilute:, paler, and of 
dirainiiihed ftpi>citic gravity. If the blood-pn^oniirft hi thu Malpi<;hiaii l>o<iiM becomee 
still greater the urine is a)bninuioTi», or even bloody. pAwrVR hti'kk.v.mk of 
Tits KIDNKV0 hiXB ita orti^Q in miLnr diseases of the heart, in contraction of ttte 
vcoa cava aud of tbo nmal Tediu. in various dtsc-nscs of the iuoiT*> (^^ Here, 
the blood increases iu the veins and capillaries. Iomi in the vessels belonfciuK to the 
Halpighian b-idies. It ia noteworthy thnl thfrn i* abrnys prfiwetit a low t<najon of 
the hluLxl in thu renal arteries and thuir bniimhiM, an] a hi;^h tunKioo uf the blood 
in the oapiliaries. The chief symptoms are. diminished arinnry secretion. Inoreoae of 
it« npeciflo {Ttavity aud of ita solid constituents, and the presenon of alboineu, blood, 
aud oasts. 



« 



Both active nnd passive hypenBmt» may be acute or cuiiOMC. The for- 
mer are inm-B nfttni acut(>, the laltcr nmKtiy chronic. 

The diaKiioaia of hyperffimia m the dead Donv is in many caaea altogether 
impossible, siucK active byperwraia rf external pnrtji (as nf the akin m 
Bcarlet-fttver^ eryaii^elaa, etc.), nf ext^-rnal mucous membranes, as well, pro- 
bably, aa that uf many int^t-nul organs nlao, disappears entirely, or almoat 
entirely, far renson.i not yet sutficicutlv" known, with the Hppo.iram'e of 
death. With respect t<j single organs, no permanent advniicc b.is b»w'a 
made, sine** a safe o]>inion ia t-eached only through lon^ experience iii 
BntopHiBs, and aineti in each Hpticia) case respect must l»e Imd to tlie blood* 
coutciita of the whole body, in tbo cadaver, byj»orn?inia of an organ ii 
generally much oftener assumed to exist than is true, especially becaiisa 
most fon» their opinion of the blood- cuntenis of aingle orjjaus in the bo<lies 



; 



ACTIVE IIYi'KfL£HtA : OONW USTIOX. 



173 



of ihoae duedv -vtho have been AfTectod with acute or chronic auaimto 
di n e M e a .. 

A ItypMrsMuic ot^n in the dead body is darker fnilored, fi-nm light, to th« 
dftrkf^t red, without any appoai'ance tif the uoruiul L'ohiriiig. Ica sise is 
•ouifwhat inrivaacd, it feels somewhat tiriuer. but iu reality with less OOD- 
m*>tfucy : ii in h«ivier. More WoikI thwn usiml Hows fmtii its cut siiHaco. 
II\ |H-ni-iuia ctiii-tlv alTccts the cupillarii's, 8n (hitt thu itif^ati has a utiiforin 
ivdu^TNi, wicliou the iuiliviJual vessels bt*ii)^ si-i-ii by the uaked eyo. TIic 
c«|*illari<'4 bare a» eKjtt'cial arcHtigfiitf lit, nn ajipoai'^ fmiii tlit>ir iiijocttoii : 
r-S/-, fiitely |>iiuctAt*!d iu the villi of tlit* uuoous ineinbmne, in the Malpij^ 
binn Ixjdiirs uf thv kidiiuya, in HtreiikH in the iiiiiM'h<s, etc. It is iiii|K>rusi- 
bl>? tu tliMiiif;iu»h lietwoen the uiiitounino^-s dejH.'nilent on injection uf tlie 
arteries and thuse dependent on injwlion of thy vetua, except tbat in ven- 
ovts byiiefwrniu there is pi'eM^iit a bitiiith roluring. If the small veinu and 
arteritH) ai-e overfull of blood, iltc Rurfaee a[)[ienra injected with a i-ed 
xiiflierijU, forms a ml network, or assiiineii a form ditfering in accordaricc 
with the dinpjsttiuu of the vewels of the jmrt. The reinaiuing tisaues of n 
hy[<emFmic {ntrt are diminialied iu aizu iu eorruapondeuco with the increase 
of bhK)(if etc. 

An increaAc of the quantity of blood ia impoKRible, without exli^nsion of 
the distriel supplied, tht'n-fure the veKHpU are found always tlilatt^d, uIko 
for the nio^tt part ehmpitrd, luxl, uii llits aceoiint, iiljiutnually lorttiouK; 
the rliliitation is fiOinetinicR uniform, .Hnniciimrs spihdle'ithn|M'd or {louohed. 
Tb*; Mood in the 6ne vessels is mostly richer than usuid in bltKul-eor- 
.puscles: the coq)U8eIe4 lie so close to one another, thtit the vi:!i»elti often 
ji[itfar 6\\e*i with an unifnrrn dark red maai, and the individual corpiisclea 
cam uo longer be diHtinguiabecL 

la a eaae of verj marked hyperBBinla oF the tangv in well -devetopod loucocythoimia, 
the Inn^ aiipcarad Uouuid, auil b« it iu tbo Hto^i: ut gra^ boputisatiou. 



A. AtTIVB, OB AIITEBIAt. HYPEILEXIA: L'OSOSfiTIOH. 

(BelaTativcorfiatalytic lij]>ersemia. Fluxion. Turgor. Orgasiuuii. Determina- 
tion of blood. ) 

Active hi'PER.kiiia consists in nn increased, and at the baoio time for 
the niofct part accelerated, flow of blood into the arteries of a part, heenmio 
either the bloo<ii>rc««ui-e of that part is increawd, or lH?eiuisi> itd i-esist- 
auet-^ in pit>pMrtion t« the force <if tin' Muod are diininished. 

The quantity of blood in a part dependtt upon thenuinbei' and nixo of the 
afferent arteries, as well as upon the velocity of the current within them; 
the niiinber of tlii! arteries ik rotiHtant ; their nha in »itdiji<ct to the infhn'uco 
of the nerves; the velocity (tf tUo currunt is deptmchMit upon the m-eater or 
less diAlAHce from the heart, and the number and angle uf the brunches, 
etc. 

That hypenemia is riTicTlONAL. which firobably all organs show during 
their activity: the muscles, etc., during motion, the stoniach and intestines 
dui*iug ilicrestion, etc. 

Aoeopllnu to RtKKB (Diti BUtttfsrtJttUtnq hh4 der ThiitigluiUifM'JtMH dtr Or^ne^ 
Vn\ \ tbe wb'jie amoaut ot tha blood of the orji:\iiisin I* prhuirily diminishofl 1^ the 
actinlj uf the luotclea, and tbitt dhnioutiou in propjrtioaato to the inuHoular action. 
The batnt of moMuUir labor is foUovred Mcoa^lai-ily by innreaiiad amooot of tba wrbole 



174 



OAraBs or active iirrEB^MTA. 



lilood. Long continuous rout rcdnccs H. In animoU at refit, there li foond Abnnt 
OfM?-qHnrt*T of tlie amount of the Mood in the heart ai»d (freat veswls, one-quart«r in 
thn miisnW, liver, wid rfammning nr^atui. The motor U]>|MUUllu< of tctutuvd rabbits 
diirinp mnwtihLt iiontrntrtinn uotitain a menu of nlmut ?.! i per lm»ul of th»* whi.k 
Hinoiint of lilmxi mom th»ii the w»me ftppnnit"« nf rattbit» dnriiiK rest.. The ikortiuu 
of the amount of blood, which h ooutaiiu'd in the motor nititaratrui iu the qiiier wtAte. 
ii during eoiiiraction increawil hy & luwm of M jwr c«nt. up to (Wi(l, i.r., an ill- 
create of HO piT ueut. Duriuj; tctauuit tiicre j« found ft dear diininatiuD of tbe tlow 
of hile. iw wpII im of the urine diwhar^fwl bj the nnilGm. 

The nlKive fACt« explain thfl lonp-knowu ^lypjcnjc nnd thcmpeutic upt* of acth« 
Mod pmwive nin*cnlar movemctila. rh well an their effeoln in nirionfl affection*. <r j . 
nuDirciitJve Htatea of the brain, and of the abUouiioai orgfaua. 

The CAfsESi of AiTivF, nvPER.cuu ai-e: 

1- CoSII'KNSATnBY IKORF.ASE OP TllE COLLATBHAr. PEmStntK LATEttAtXT 
FROM OOfa'TKUcTIONS IN THE UI.OOD-STBCAU : SVCallcd COLLATERAL HVl'CU- 
MittA. 

The olistniction may lio in the arteriM, iii the c»pillnn^>s, iinJ in the 
veins; in tho lust case tlici-e arise siimiltuneouRly phBiiunionanf b<>lh active 
ttnd jiatiaive hypoiK-niia. KuiniplcN of this kind of coUatPi-al hy|jvt-ii>inia 
I'roijucutly occur aJuo umlor jihy^ologicu.1 conditioua. If an nrtwy bo 
iigated (tliL* bwit fur t'xi«?ririientiili<m ia the lueaeutcrio; surgically in nm|Mi- 
tatiuiis), small bn«iclit*a ext<?n') out Iat*'ntlly, ami the blooil lluwg thrniish 
them with ati-on^^fr prosHiiif and inm'KKttd vcluciiy, and througli tlif OH|iil- 
liiries into the vi-ins: sninll, foniurly [mlwIfSH arteries, ovi-n cnpilU i*'S, then 
ahow H pulsation, which can be neon and ff^lt, ami, e.ff,, in aniptihitioDis 
give liso to remarkably great htrinorrhaKi- ; parts of oi-pui», whiith heivlo- 
fore wm* pule, bfcnmc roddpnetl in greater uv less iiit<*nsity. Th'^o condi- 
tions of the circulation oontuinc nnti! tho excosoive atrfnim is distributed 
among tho many lateral branclie^^ and so becomes equalized. Ui-eater 
olmtniclioMK in iht* ratpilhiry ayftteni of an c>rju;nn or part of iin organ, «a by 
constrictiiij; ci«itri*vR, by iiew-fr»rmatioiLt of all kinda, by prosanre chivtly, 
by wipilliiry enibnUsin, iu the vicinity of inflauiLil [jarta, give rise to nei^* 
1>oriiig h_v[ifi-n,'Uita. In niarkeil nicteorism, etc.. wo not infits|ueMtly see 
bypcnemiii uf other parts, f-ff., of the birain. Severe extiiruid cold^ aji<l the 
eobl stfufe of fever, offer further strikiiij; exaiiiplea ; whil« aiuviiiia extends 
tlifongho\it the surface, the blood flown in gn.*ater qnautity and with tjnHit^rr 
force into the iotmTxal orj.'anK, giving rise to hr|K:netuin of the vixoeni of 
the cnuiiuni, tbomx, and al>douien. (The contniry is seen in tlte ap|;U(?K- 
tion of JiuiotPa Ixiota; the extn^niitieH K-oomc filled with hl«K»d ; thea 
results cnllateiid aniemiA nf Mie bniin and Inngs, with conse<)uent vertigo 
and hIko-tii'-ks ftf breath.) Iu the veins, eolUlerul hy^wnemia is mostly of 
little inipoftjiiic", beeanso their aiia«toniosi'i) are very numerous, and tj»eir 
walU thinucr aiid more yielding. Contraction or elosnre of a aniall or 
middle-aizo vein is uninipoi-tant, if its enllateral hi-anehi'K be nntnrroua; 
contraction of the anperficiiil vcina is followed by dilatation of the deep 
veins, anil vicc-verwi. If all the veins of a part" be closed, thinr hlood haa 
tlie same lateral pressurfi as the afferent arteries ; hut if only a few vcina 
are inipussable, tbe lateral pressure of thu&n roiuiuiiing open is increased, 
and the velocity of the blood is gntater. 

Oollfttetal hypenemia hna a promiueot MpiiBcanoa (If we exclu'le mirfrind rasea. 
where Ka iinpurtazicc ts at onoc iterueh-vd i u^iiectiUly iu iuau,T diM'ases of the Initir*. 
eg., in tlirmnliiwii and cmbolimn of th« puhnonarv art^rritw, lu iufiUnitiuTm, tMiijihy- 
acma, o*>inpni!wioii by plenrat exailntions. It nometimp* ociiwioiiR Jyspu-i'i. in. well 
as death ia the oarlystnges, f.ff.. of pneumonia. In compretiKiou of onu hiug we *o* 
in thia way collateral hyperemia of the other ; in pulmona^ umpbyaonui of tbt 



CArsES OF AcnrE iiypek-kmu. 



175 



npper lolms, wo fiml Ityiwnetniaof tlia lower, and theucfl hr-mclntit. et<i. CoIlntenU 
byiM>TWniin In 1ikt*wi>«H importjinl in no oallej granular kidripy ; lirre numcroan glo- 
mvrnli and tiitnil<?3 lure dci^trojed. i*o that the blood l\nvcri ihrongb the r4x>u voaHcIs 
with irrentcr v«looity luid under inorcAMMl prcniiurc*. The quantity of Vac excreted 
nriue is nuriuiilly iiri:at or iiicrca*ed : the urine iiaeit in clL-nr, jxiln, oiid of lijfht «[»(>- 
ciiic weight. Tlic iitditv of h'tt Intuil l>nlli«, of load irritutlouo, de|H;nil8 ewwubially 
on llirir jinMlufiinc colbitrral h^-pcrfrmia. 

In c<i11:tt'rml hj-|»nwmia the lu^MiD-ri'RRV.XT mnomctimct to ho foiiuJ Tl'KNiiD rs 
Tnr. »n*iv^iTr iUHKCrKiN, Tlii* in most cnsily observed iu casL-fl >>! uti^al vMutcraX 
extension uf tbv e|>i(;nfltnc and other voiua. in comx>Icte olotiuru of llie ttxiak of tha 
T«nn porto^ or in (rrnuulnr liver. 

Sampei. (/A-W Hd-lfA., ISIW. No. ai) has experimentally domonAtmifld timt the 
iiervi!« Hxeit an inlliittnoe ou lb<> ncc()m]>lixliinfint of the ooUattTnl RtrcT]ln.tion ; it ia 
retanl(.>d in pntiKirtiun to tl]p M^nnun' nen'OR cut acroM at the time of liffatin;? tbo 
oaroiid. lint if Hw oarotid he lignt-ed. and if at the same time, pnrnlyuis of all throe 
•ensnry nerves (/«. iiurh. itinj->r iiud tfn'ii"t; imd ituric.tytnf),\ atu\ of the cervical 
■yinpntbeljti bo induced by icctluo, tlui collateral oirculaliuD will be roaturod oliruadjr 
by the Mcond day. 

2. Aesoi-rTE dec-hbase of mwisTANtE. 

ft. Quick iiRHovAi. OF KXTEKVM. PUKsscRK. Tf Jipart lift* been for a long 
lime subject, in ii uoiTimi or nVmorimvl maiiiK:!', to a «>rtftiii prt'ssiire, tlie 
qiiicfc reniovnl of tlic latter occasions an active livpenetaiu iji that poi't. 
A4 uxamplea : Inuinorrhayo int'j umjitioil (.rzwitirtii follielL-a; dry cuim nticl 
Jouiiu^l's buota; punoturn of liytlrticelc, of lutcitos ; floctioii of the ocwlftr 
iniiscltfft in o|>crulion8 for squint; that of th<- cornea in opci-utions for 
caUmct ; vxtnimliou of largt: tuinurH, which cL>iDpreBB vesHols ; beuUtig of 
fttrtccurea. Dvup inspirations <Iui-ing <t>ntnictiu]i of tho glottin, t'-i/-* in 
hkryngeal croup, arc followed \>y i-ftnifuctioti of the air in the bronchial 
tuN'M and air-cells, and thcncu bv hypoiipruia. 

h. KEiaXATIOS, or I'ARALYhIS of tub )lt;8eLES OF THE WALLS OV THE VES- 
SELS from GRBATtiK H'AKMTH, ov fi'ojn lUrect or reflex paralysis ok the svm 

PATOKTU"; BlVCJlliwil RKt.AXATK*R, Or PAKAIATrc, or AHTIfF,>"H' hyiteitDTQift. 

KxTEasAL WAHMTU jiiv(\s rise in many cjustrs tn hypom?mia; its action 
iu thr form of baths, foroontntions, etc., la often employed thcrapentically. 
Ill a ftimihir manner thn ht'At of tlie binod nets in fover. 

pABAl-rAia OF THE SVVI'ATirKTIi" in dill rrt or ItHfX. 

t}iRBiT rARALV^ts of thi" fibres of the .syiopathiitic takes pluce in their 
course, at their origin, or at their tennination. 

SstTios OF THE 8V)i('.\THKT[c ulonCj iw it hii9 vory offcu heeu pt-rfiiruied 
In various [tart£ of the body, for expi-rinientjil piirposcf<i ia one of the ut<)Ml 
|>erer>ptil>ie caitaea of hy]jenemia. (See p. 160,) 

Becliund of other, mostly utXED nerves {e.ff.f tlie sciatic, ulnar, 4?tc), 
or of purely sensory nerves (e-ff-y tlie trigeminus), which have hap|>eiiHJ 
experimt'titally iu animals, tniumatically or therajwutically iu man, act aa 
if th*MO uorvtwi contain vaAo-motor fibre.s. Alao pressure upon tluae nerves, 
or new-formal iona in them. 



The best known and the most important sections of nerros in eTpcrimentid pAthol- 
ogy bare been those of the triypioinna, which, since Maoenoik (lH-^4). have been 
friMjaeoity repented. Tbi'^ii fledidus arn followuil by bypeneinin of the conjunctirn 
and oumea, of tbe muc>mii m«iii1>raii'^ i>r tine mouth and nouc. with oouaecutiro dis- 
tarhanoMi of nntrition. M^uiy pntholojfiml ctlvm nlno nr« to be traoed to the same 
oaaMM, or to (».>n)prew<ion or du);enerAtinii nf tbitt nervo, >)nt iu>ldoiii to tlie kuiiu 
airortioo nf otlicr nurvftn : ao called dikiict nisi uai.uic »Tr(-:r;.KMi.B, I'.rt., hypcr- 
Viuin. olevntion of teinpcratiire. and for tTie inott part al!"> swi-Min;,' of the rntno 
pan*, appeariag during a ntmralgta or remtiimng bohiiul after its diiiuppearuaue. 



'nn 



CAU5BS OF ACm'E nTPKR.«>nA. 



WHirtht-r airi-elioiiB of tlir tfrmiiial sympnthctic uerves cniLse liypenEia 
it iH t'lir till' liiosl |ii(rl diniciilt to deteriiiiue, since many atfecuous of X-k 
kimt muy uIbo Ih* rt'tU'X. in clmrautcr. Tli** sfj-CHllfd uwritrt/itnui cirtoi^f^ 
(itiirix nrtrrifiti*) |ii\iUibly W|oii(^ to this class. Vhi-ious affE'TIOSS of 
liiUtN AND AriXAi. ix^ut) givn Hh*' to liyitL'iif min, otity tlii-ough the tiit4>r(»om'. 
tioit of Mil' sviiipitlK-tic*. In this ivbtiort uiv known the hyjienipmLit li^ 
pL-n^Iunt upon the mnotimm of n violent kijul (fit»r, auger, pjuiMion* wiktfuj 
iliMiinu)* anti thost' fotluwiug ityiiriea HUt] luany diaeti«eB of Uiu spiii&l con^ . 
luM oftiin oftho brain lutd its lueuiuges. 

llriMiR. WM.I.K1I, and 8t-ittKr Ant deraonstriktevl that injuxr of th« mMoUk gfr- j 
lotitrntu hihl Ihn BKiiKt iN>nMWiiu<noea vuf si'i';{>>ii nf tht! »riii pathetic. In wectkm 4I • 
latoml hftlf of thi< iito'liilln tlim- np|H' '.mta nnil tiicrt'ostg of lemperator* id 

th« l(>wi>T pitrtn of thf vxtreiiiitiea f>n ' i die '^.-cttoii, i>f Ibe bodf. Bpycmt 

u»l ujipttr put of the thigh 00 the oppt^w «ul« {Schipt). 

KKri.icx riK-ii-Y-;!!; ok the sY^tPAroETK' arisra moat often trom i tf ib ^Mi { 
of t4«Mk>uiry ixi'i-Xi'-i. T)ii< diluting lurtiuu of lui irritated ■uiaoty mnw dn ' 
nut, for the uiiv&t [Mrt^ rxtrutl beyond the liiuit of tbe ir^poa suppliaJ V 
thi* udWl***! itfrvv \]K 1(>'J), The rrfl<>x act taJkes (ilant |ii>t>I»Uj in lis 
nifthiUii oblitntr^iA. lliitt n<l1t*x {Ninklyvis of tbe nuo-nvotor nerrvi hai baa 
G\|H>riiit<*ulAlty i1om<>ustrfttnJ iu tmioy viis.:iilar rv^ons (itrt, <cHnrwUru,<at 

U>vbl (ar. 4 'Sioli, ^««i. 1886, p. »). who oude tb«e fru wi h a w i lw , AMii 
fvirth«r iImI urHkHos of th« wwauiy oerw. beaMen omwIi^ itiktatfaiB of tl» mti^K^ 
1b »bo f oQaw«llQr a retenkOioii of thr Wut^aaedoa, aad tfaatibuHTarati— rf>l i 
t— wU t» rtftva ^n««4ad by ft eanerMtise «f aihoct dwattOia. ' 

^■■1*' « id thv h . bea i& tba aCnrt «£ «U «»«a kk» mtb 

AriaaM-**--* »u*i i.-m msnlluif •krAT'i>3 k>i um aitaaall 
MK. aad Mfkaya iOl athvr oomf WMalniy 
JBawMi alataoA-ywara. tha du^mt bawiiaa 
ffettaiaof tha anaanaaMMon. ata. 

rii^ilM iliiii !■ llili aij mts liii iii|iliinil ihi kj| iiiaafa iif Iki i 
■aaahtaaa. irUdi tnnmaHij Cottews tslMain ban 
pmemify h ika <aa4aaai» l« iMiaaiitMt aad iikiw atiia i, 

H n«CIIXK (TuULVAXK. ffliiaf Mk r«r«r.. tSTA, Xa. 10» 
•aqfiaU HMCK a» a n4ax lan^tfria of Hha naa-aH(« I 
, depaadaat ayaa iiaaMalifi caacvaiM. Sho^ * 
tti^^aM aad aaaa^t^ of tka 1 

gaoMMMM of dM >iiaa^ altar a»Uca aal paas kaaa •€ ' 
Maaj- *«ifiDal oparaliaai (i W aalaaa af laqpe 1 





8MBA or oMliwaoas «aaae% or o o eiri^ ^nM? ck; i tcoy t aC 
iHfli Im^ bectt ka»«m Vat aot 1 nilnaiJ- Ibcv vv Ww ' 
■otO M^ iw hf t w rf Aaooigia trrttalianofh; clkss af tW 
ov«ra»er4Mh «f iW nttaA, ua looCk-aaW; hj|i !!■■■■ af li* 
naak; y tiat a i i <ittuic irrilaaaa of iW mtLra !nr gasaofemi 
r Tigiiilij— of Iha Kaac ftai miiif >■■ Bn»oga a»i attwi^ t^iemi 
arr TiiTfifia fro« A» rif iiiHw of nvy oail. itiS aftnar aff ^ 

>Lmi5 iHidM ^ ftml, mtiamma^'imi fmmamai^ ace <M n.ag, 




^:i« 




CArSE3 OK AfTIVK HVl'ERKMFA. 



177 



tWndlo proJuce, first, a coulnu'iioii uP the siujiIUt vess-*ls ; tliPii, longer 
^ yetl, H dilutatton. KU'ctrio ciirn;iiU g«imraliy contiftL-t tiie vesauls; 
rt slrrvng nirroutfl oRperially, aa well nH woakfv nnr« acting fur a long 
lae, diltitc tlioin. The saino is true of volatilo arul Atrcitig iimU'riiilH, 
luch produce redness of thu skin (luiiatanl, diuthariflesy acidis aiiiiuoum). 

O. XBr«.0<N {Prag. ^J»cAr., 180:J, I., p. 1; 1807, L. p. 133). u well m Mastk- 
iVA i IW6). hare eXAmined the phyfurVlogioal action of trritAntsof th« *kin (so-oalled 

TItat many (-ostaqions nnd iilAsus are foUoMrcd by coiigefitions nf oei-Uin 
pins is a. flubjeot which belouga to s[wci«I |)ttthology. It is an intrn-i-atiiii; 
rt that these coiigestionn vaiy in diirei*eut e)}id<.'<iiiic«, accoixllng to iiiC4'n- 
tVj fxtenRion, KR-ality, »*to., e.ff. in 8<^ari?t fovHi*. 

ID iiuiiiy ciiiv^ii hy|)ei-n>niia of a ]>arc folluwH anemia of the same part: 
pfdally is this trno of aiuoirti:*) dM|H>mli;'iit »i|irtn extoraa! colil, as wt'U as 
•oil t.Mt*.'itn(ion of the Nyiiipiilht'iic. Thin is iii(i»t. favorably i1enioiutrat4'd 

the pr'niucli'^u of hxial auMsthpsia by rnnuiH of thu I'tlier spray. The 
itftt* hiMi' lir)4 |inrt.ly in thn n'lnnval of tlto iiiHin>iioi> nf Ihi* iiervvg, tiartlv 

an pxhiiustioii of the smooth itinscl'.' fibres. 

C NfTHITIYB DISTUBB.UiCES IS THE WALLS OF THE VKSSEI^, observfld iu 

cir ligltter fornni in tho vicinity of wuuii<l<i^ in iullanril purtjt, lu well as 
their more raarkiitl forms in ehroiiic arteritis, fatty tlo-gttne ration of the 

mculoi-coat^nt^;., lutta often the case in old [Mrsuuit. AL-CfU;rati><l niovenicntH 
the heart, from wliiite>*er cuuw' (ntovempnts of (hn bo<ly, the use of Bj>iri- 

ous Hr)iiorB, «niotions), ore thuu iblloweii by hyiierwmiie in the regions of 

• recttstanra. 

Accnrdtng trt Vinrnow, intproarront attack* of vertigo, loss of oouNoiouimejw, faint- 
r. are, in »J<1 pi!n]ilu, ofton the w)iihi.'<4Ul'Iiccs of tliis form ti( lijr)j(.-rn;iniu. 
rite caan«0 of many t'-tU-rulily csiuxt.-ntt, imhI Hvinifttiiimtiatily not ntumixtrtaub 
{Wiainilja are unknown : cS'is the circunrwyibwl ntdn'i-'w ami incrH.-ineil \rjiriuth of 
e obc«k iu pucumoma. tuooUy on tho sniue side as tbu tlincasM hin-r, thu oiitnim- 
■tbod rednMS and elevated tciuporatutv of both ohocks In taborculoHia, etc. 



The cjuiatis of Ihp HABITCAL TKVDEXcnr TO coxossTloNS wliich ranny indi- 
liiala jirt'wmt, with n',+i>ect to e-M'tain organs, #.y. the- brain, lungs, liver, 
liMjys, thyroid glauti, am nuknuvrn. They may dt;|K5ud upon a low |K>wer 
resistance of the arturit's an<i oipillarirs, as w<>1l as npou spueial condi- 
lus of the sympathetic, or fMinsory iictv»«. I.ikowtao is It unknown why 
hyimrtnipliy of tho lf?ft side of the lniai't prtngi'stions often a^ipear in 
rioiia organs. Tin? nmnifold congi'stivn sintus uto also worthy of noticp, 
tich appear lii giila before tlie first apiMMirnnce of the m<>nwj<, or iKjfore 
e appeanince of each menstrual act, as well a.s those which appear in thi* 
mactcric yeara: in (ht; formci* the thyroid body is most ofton aEfectetl ; in 
r> Utt4*r, various organs. 

Tlie »VMPTOMs UP AiiTEUtAL ITYPF.R.EMIA are easily ivungnized extenudly 
parts cxptwed to view. And yet a situtlai- bi^haviar, also, in hyperA>uiia 
inttfttuil organs can, with the greate-st probability, be inferred, eB|»ecially 
ic© a nnuiluT of inti?rnal organs, in the )iypemMnie sijito, have been ob- 
'vod iniinfulialely or mediately (by tht- tijihthalinoseope, iHryngoscopo, 
:,) »iUi till! naked eye, or by means of the n)icrosro]>e. Tlieir kn'»wle<I}^e 
00iaje<8 important from the fa'it that many affections of daily and hourly 
currence to the physieiau, for the most part quickly appearing and quioklv 
12 



ITS 



STMin-nMS OP ACTTTE HTFEKjnoA. 



(lisappcaviiig, dppotid ni>on thom ; ami that l)yi>eremia is tlip introdDCtion 
to raany biemon-h»sos, di'oiif)i>s, and eflp^cially indummatioiia. 

The Hymptoriis of liyponemia ava partly tho*e wliich i-esiiU dirocUy from 
tlu- itierense and accelerntion uf tliH hlood-cuiTent ^injection, n^luess, piitm. 
tioii), p<it-t1y thoHH whidi iiro distHnt i-«sulU (elevation of tt'uipt;nitui«, 
swolliiig, iiiorcasttd nutrition). Tim luMfc, incn-nw-d nutrition, resnltji eillierin 
an increase of function (the so-caHfld fuuctioiinl h^'porsomia of the musrloi, 
bmin, glandular organs), or in an increase of aecretion (skio, kidneys); or, 
if of longer dunition, in hy[ieriniphy unci iifw-furmation (aometiines oa fkt) 
sonietiin«^ a^ true hy[>erLrophy of the miiscles, mmetimes aa heterogeoMcii 
new-fonnations). 

The Ittihavior of the smallest ai-teries and vfins, ra well ns of the capil- 
laries and IvmphutioH in livperwuiia, ia Htill little known. Dilatation of 
the hloorlvenfM'la i» easily and with certainty established. Doubtleos tbejr 
beeoiiie inoiv poi-ons, bo thut more Henun aiid plaxnia pjws throngh thftr 
walla, while rod and whitM iiIo<xl-i;lobides do not, as in iiiflamnution, 
usually pass thrungh, or only in insigniticaiit numbers. The plnsiua-Uyer, 
Kit<c;tlled, perliiipK i)i>mj»[)ea4'a in Mi» anialler arteries atid veiiiH, ao that nd 
anc] white bluod-corpuitcleH till the whole ve.s.set. The bl(>o<l ut first, fmrn 
niicriMfcojiic observationa on the web-nieuibraiie and meseutiiry, fluwi* more 
quickly — in conscquenoe of the diminished arterial resistance from dilalo- 
tion ; if the arteriole be conaidembly dilated, the current will become 
slower — iu consequence of the iuci'««ia« in aize of the ehauuol. 

LoRTKT found ill the horse, that tho Telocity of tlie blood in one oorotiil wuooo- 
liderably itK-'reaHvil duriti^ li^^liuu ot tlic Kaiue vetuiel of the other itide. DootSL 
(aOD p. 1<^-] Cflulil uot cftrrolKiratd this in the dog ami rshhit. 

Acoonllu:? to the a«iially nceopti'tl vinvr, the ijli vsTtty of lymph fonni in a partflf 
thft bo<ly at a given momRnt mcrea-ws with the increased blood-wipply, as w«ll « 
with the hinilerhi^ of th« rctltix iittn the veins and lymphatlea; lymiOmtiat ani the 
chiftf rejfTilaUjra of the turyv)r of the cissuoa. (If thi» ret'ulatiou lie pravutited, a^d«^l4 
appcan. I 

According- to OoLOi ( Virrh. AtvA., LI., p. 58^1. the periTuottlar lymph-tpacei «t 
the brain (which accordinn to Q. ans eounflctud with thoaie of the pia and iodireetly 
vritli ihdSM o{ thi! aroctuiuit] I are caiaprun.'^L-d iu the morv Tij;uriiiiii filling of tho blood- 
vcifwlx h.vpunBrnia), but are filled in iliTiiiniKhod blooi-pressure. 

QjKrmE:i6 {lieitr. r Circtd. ind. fy-MlfUtiJU., ft-fiji. Di**., 1 872) injected deflbrinated 
blood iuto the oarotid of a hone nii'ier hi};h prennnre. and rooasared the IriupU 
flowing in Hhort fixed poriodn of time from the \tiX)*M cervical lyiuphatic>4. With Um 
bcgianing of the iiijuctiou aud immudlatoly thereafter, tbu tlow of lymph rr>9c ooo 
aidemhly, and indeetl so qnickly that it i»ruld uoc Im! assiiTiiod that there wras oa 
iacrca*rtd transadatiori from thft Id^mdvemwilft into the pfrivnsnnlar upaoPK. but * 
mechanical prejwnre of the tlaid rnit of the latter. Herein consists tho (Kjasibilily of 
ft quick equaliixtiou. und«.'r sudden increase of blood •praasuro within the cnuual 
oavity. SbouU the increased presMure be of louger duration, an iacrcasod ttanaodi' 
tiou takes plaoa, and with it islema of the brain, with aymptoms of oompr«nioiL 

A stronger filling t>f tlie vi-anel-s, so-called Injection, i« tht; must atrikinjt 
symptom of cotif^-rstivo, hyiicnemtii. At Hi-st the arteries are the vessels 
concerned, sometimes also the veins ; for tho most part then there ariaea a 
close capillary injection. The latter is sometime*} circumscribed, somettinei 
fliiruHt'd. CiTtain organs nro morn disposed to circumscribed injectioiui, 
aiuoe their vesat'ls have relatively few atia-btomoses, <?.y., the lungs, sjdceo, 
kidneys ; or thei-o are certain parts witliin tho organs which serve u ihd 
seat of congestion, aa the Kinall glands of the skin and of the mucous mem- 
branes, tho Mrtlpigbian boilicit of tho kitbioys. Injection is most mark<*<) in 
clear atnl tvans|mrent orgiuis (conjunotiva, retina), as well na iji soft pliablo 
parts {e.g.j in tho mucous mumbraneS) l<JugS tM opposed to fibrous uvil 



STTfPTOMe OP ACTIVE IITPER.ICMIA. 



179 



osseous tittsima). In o]m>]ue pHrts, e.^. the skint there is fonnd only red- 

'i*be BfEUDEXiNU of liypenemic parU is a ouruieqtipnce of the greater ()iiati' 
tity of \i\oin\ iii the Jiltite-U vesst-ls, as well as of the greutcr |>rujii>rii<:>n of 
blow! -ginl mil's iti lliis blorwi. The urninjj^'iiit'rit itf the vtfsst^ls ami rcliitionH 
*till iiiiktiow'ii j;ive it vaiitnitt n>i-iii!«: tt \s piiiictifonu iu orguim vhicli uciii- 
tiuu p:i|)illn* or tiifu, sliviike'l in mtiscU-s, <*tc. ; it is hoiiiirlitiit'S KpottiUil, lU 
iu tneiultftt; noiu>;tiiueii more piinctHti^l. u.s in soiirlft fever; so mu Limes uni- 
form, as in erysipelas. It is mu»tf to JiMuppctu- by pix'usure, but ou ita 
removal rel»ru« a^uin very ([uiokly. If thv hyju^nt'riii;! remain long the 
trewels become ci:'iihi<lerably <li!at<nt iinU tho circulatiun i-uuirdcd, thus 
giving A more inti^ise coh.r to tho lilooil-^hilmles, anil consequfiiily a 
bhiisli-reil cnhir to the piirts. as is most ofl**!! seen iit [Hirts of the Hkiii which 
have been chilltnl : thfii unvlnr i>rw»ur«' there nppeuns at first a brick-i^ed 
eolor, latter only the bluisb-rutl coh>r rcuj^pcur-i. 

Partial cootrcative by^ienotmA (in t1io hautl or fai>t) vtuit seen by EKhTBB (.IrcA, /. 
kUn, CUir.t X(I., p. 1) in no-ukIl<jJ orturial tniuHrasiun. 



The FEELiNti OK I'UUiATiOX, whioh the nick often experience in congested 
parte, ia in oonKHijiifnof* of the {liiniiiishpd elastiriiy ami trtntm of (he 
resat'la. T( is chptvially fi-oi^iieitt and ti'tnibleKoini.* iu iK'ttUiu-htf and lootli- 
achi'. SocilHtiniL's the pulsaliim i.H uhjtrctive, e.</., as in puhntio rjiii/tnttricn. 
Ill many caKes a pulse i» felt also in tirtortett which ilu not noriuully tihnw 
anv piilhaiioTL 

The TEMrKRATiiTiE of the hyiwrieinic part rijtes in conseijnence of the 
more rigorons tiow of blno<l into the dilatt-d vcrhcIs. This rise agnin *Us- 
Bjrpears after previoiia section of the cervical sympathetic, and after 
conipre}«ion or liicntion of the supplying Hrt«?ries. U does not up]>«iir if 
before HHCtion of the Hyin|»athfMic the carotida and vertt-'bi-al arteries liave 
b«»u ligatod. The riw in ten)i>eratuiTe is not merely with respi-ct to the 
feelings of the sick, whose external jiarta are accustomed to a lower tempe- 
rature, bi-canw? these lose uiucb of their warmth throtij^h radiiition, but it 
iaalao objective, niid reaches to 'S C. Fur the patient the itim-iise in lein- 
perHture is somettineK the uuly and most troublesome Rymptom, r.j/.^ in 
coajjeationii of the face. 

Exp<?riment* of Bt;ttNAnn. Krs«MAni. and Tknni;h, Vikchow. ficnipp. 

£xf)urimental sectioii uf ucrvt-s. f.g.. of the bmohinl plexus, of the acintio, ia foU 

vtui i}iC!*klf^ by tb'« lu8H ut motion atid seiituittonk by iunnediiite dilatatioii of the 
leU and innreiwe in tempenituru (Berxahd, ScniPP. ^U: \. Similar tianeB from 
■bpt woondB of tlie ncrvusin man with ooiitu-eutivo elevutinn of tisTnpftrntnn* w<jro 
in the lat« Anierit-nn wnr by Wkik Mn<nKi,r,. MokkhiUisic. nnd Ki;en. 
' the unaAH from Uuniati patliolopy oppuscd to tliis. are to bo explained h.v the 
fact that they csime under n1iHt>tv:4.tiou only nfler a luu^or tiiuo nfcor t>liO n:c«.'pLiuu of 
the injnrj* ; then mn«t.Iy .itagnatinn-hypHnHmia, retiudatiou of iha circidatiun acd 
decrpfUA of temperature werw prenpnt. 

Ejcia-riuiental flcctioufi. UccrationB. etc.. of the u|^r pnrt of the flpncAi. cord. 
HJc^wise isiUNG a coiiiidomlilc increaite in thn t#mr>erat«rc of the whole body lor 
fever). Spmal paralyxM le^w freqnpntly thnn r.hosn uf peripheric uri^n nre followed 
by riie in temperature, etc. HtJTt iun-hox fodiid the lower cxtremit-iew iiffweied 
by A pun)(«--nt heat after injuric;! in the low^r domnt nnd himbnr region, their nkin 
dry, the tibial arterie-s more ciwUy felt, dilated aud tbrobbnjg; their teiupemtiire at 
first w»q conxid4:rsliIy inereaw-d. LcviiMl and Coi.IK M«r BJtnilar cffecu from 
hwmorrliaye am! infl.iinniation of the spinnl-conl. 

In L'tUKBlt.vL hemiplefcta. a riao in the toin]M<ratnr« of the pnmlyzed is for the 
moat part f jund at drst, however hardly reaching 1 ' C. The temperature becomes 



tan 



mattatA OF juTnrE in^ERjoui. 



ftlegia lk«aais«orft <" 



f of tkelMmir^^^iik In Teiy lou^ dumlion of I^ImbI- 
1 CMtptntnrv it frnxul. 



The sinaxi:«o tii hyytrwrnic [«ra ts moittlr trifling uiH is to b^ wn il 
once in th*» altth, TisaW* momus membmoes, thyi-oid body. It nBiuilr 
i^rfiean morr RMrfcoi onH nfl^v it longftr riumtion of tbe hjjieiwiuia. ft 
is grracrr in pmj*irunn to tlif ^lucQlftrity, »of)np«s, And pliability of Uie 
tisstif^ AS, ».y^ ia Uir ^f ^»hick?ned cbepfca from himors in th« gumt), 
in the arch of ifce (aiiAte, in the thyroid body (cougtestire goitrv). Tho 
Rw "" , ' ' or^^un is not uifrp<|ttcntly jurvented bv the M^ 

f' incrtMse in size of the bmin by the okiw*! bIuTI. 

a" . j.plr'on. kidni'VH, etc., by thi-ir cnjisiiUits. Tb« 

111. •".•^.•i^ls, •* exudiition of hy[»enpini3i,'* occurs 

ftooi>iUiu^ ' '■, *^ teJvm* (oollatenil ieJf>ina), as drop^, ah blcoaor- 

rliuA, tmu'.' ■ unrif. as incrcnaril wound-wH*iTti'ni, etc. The awfll- 

ing Arises '. of the capilUiittS wmi ibt-ir iiii'nwr |Kjnft«tT. 

iu tsmacqu ■ s.niin or plusma is tniiisttdt^d, thnn can be 

duried awiiy by Uir .arat?d by trunsfurtuatian tnto tissue. 

The oocomoo eaMs of Aonte rfaeamAtum of th« joinbt iroiuuitt in hypcmnit ui 
mraae meaamoiaxioam in Um oantiM of tbe joint Anj id tbo pArtH surmuodin; tJun. 
This it clemoiutmMd by AXAnuunoRs in tiie Urlatr, And [KThujid a\tn by lu <iiikk 
»f>ttrnrMicvt xml <liaapne3insioG (■fMrntaneoan, or after locul th'.-ni|ii:uUc mtcrtereac*. 
p!< 'XtAlljr funiwb ntyatiri* rH^iitl^. 

A'la■^«^ iM'^. 0*M . Nuv . |Stitt»ad\'i>ic«thatc«Ttntn iminfnl op»ntinoi 
fr — htcd h«niiA. rvtaiitml iif foiyifim ItaxliM from tbo canAl« of Um 

I,, vhcie iKMffiM" OTilv aft^ir prooodiug local Anio&UuMiiAlian tbj 

in i : . ; fur i^iAAUJ ixritACiuu of MUnUtivetiervcs prujuces loual dila- 

tatiDQ of Utio>l-T«Maeis aikI cnmnlnff of Lho aSxtAul ^muuH wiUi blood. 

ILutnitKMAGKs worthy of nntioe Ap[H-Hr only wh4>rn llm res-H-ls ven 
nlrciidy biiitlf, a» ia oft«u the cas* in the bnuii ; or after vury Middro 
rntnuvAl of rxt«--rtutl pt-nuiuiv (opeiatiou tur liydroc>clo, ascitt^s). or id upen- 
tioufl fur cutAiitct ( hirmorrhi^e into the retiim, evuu with iU detachment) ; 
or in veiy ijiiickly appfnring L-olUtvnil hypenemiit, iis iu tlio oppuHitp tadej 
of the braitif nftor hgution uf thi; oommon uArotid ; or in more frf*«)uenti 
ri'tum of liypt>m?atin, Aiid^ when tjie tiitsiies «re tendor, an bletnliug fnimj 
till* uoso iu cliildliuod, bl('L*diiti^ of thu Air-|iafuuigoR uiul lungK in youth, 1 
Cfn-bntl hn-'iuorrhiigi.' in mon.- udvaucfd Age- 

According to more recent experience, very sraoll bh-fslingn from tbe nniDJuival waX\» 
of TPs^elM oomr in ttr^ry bjTMtwioia eren of rfiort dnrAi Jon. Bat aIuo ^omoirhiu 
^Tfat^T cmiiilliirr Mt^eilinf^ tAltc pUoe, probnbly vetr nfH-'n in hyiHinumio |>ArtA. tmt 
for tli« ina«t part prcjient no BTiwprora«, 1wo«umj the blood exadc-i is CArriod awAj 
AM fooa OA it re«obefl the orifin of tbo lymptaAltiM. 

Pais in active h^-iH'm-niift is often wsutlng; or it is only dnll, or a neum 
of lightii(.*.sH or of heat ; it is rnrely st'\erc*, xs, fi.ff., in carionrt tt-etli. 

Fl'N«"rioSAL bisTt'iiHANcES iu coug<?«tioiiK aro of ^iirioim iui{KirUMioeL 
Function i» nomi'tinifs HJightly more nctive, KometimpH enfeoblctU In k'OS- 
OESTinss or THE VHAtM thorn arittu phonoinMna soiuptitnee of irritAUon. 
Honiotiine« of pressure*, Hometimes of both at the same time, 8om(.'litiir» 
only of tlio fornier, aometimuii only of the latter. These phonomona Wlong 
to the psychical, sunhury, and motor apherwi in varicms decrees and propor- 
tioHH. Most often tht-re exist avmptoinH of iniTcust^d irritability (phnt» 
pbobin, irritubiliLy on accouut of noiai'n), tliwbes of light., huiaTning in tli" 
mr», fiinuicitiou ; besides, a fueling of uuivsc, change of dispobition, gidilj- 



( 




8Y>IPTl>M8 <1F AtmVK nVI'Elt.EMIA. 



ISl 



hftllTicinaliouB and illu^iuiis, even dolirium, soiuijiiiine^ convnlsiacs; 

Btimes attacks of mania, etc. Every increase of bluod-ju'es.suro iri the 

Erftin cAiisi"t excitation of the nm^i eur/i^ and lu-uw retlnction of tlie indite. 
The symptoms of L"OK(;KSTinx or the spinal cohd »iru t*lili liftlc knowu ; 
this is in |Kirt the condition in ainiml iintation. In active h_vi>t;in_*miii the 
SKix is atrt'clt'd with sensftliouM ofheiil, prickling, it<*hing. luid lui imi>erfyct 
S(;tuu> of toui'li. Coiigt^Htivo nvpF.ii/Rut.c op^ Titc I.UX09 of moderate 
|>rL*8f^nt no s}'ni)>tonts; tht'y ai-c followed hy a lively intoi^hango 
High dcgre«--s ciittao diQiiuia]|i.-d size of t)io alveols, ahoTt- 
of breath, fnliK^sti or cunstriclloa of the chest, u^thiua, soiuetiiutiS 
Bhort cough; cxptjctoiiitiou uf frothy ^mln sijvaked with blooil is ituldoiu 
' present, in the highest gi*udeK, wliieh f(L>niutinn>u iip{>viu* lu mi Ht-Mito ntl'flu- 
tion (without demonBtrable aiii.su, ov after c-losun! of the puhncHjary 
arti'rieB; ajioph^xy of the lung), are Bti-oug constnction of the cheKt, even 
dmij^T of RuHVH*atiou, giviit dyKj»ri(i^i, frutiiy tiptita (u* tin* Kutitt- uiixt*<i with 
' Uuotl, etc., — fiiiuily Iho 8yuipU>m» uf acuU jiutmutuiry ludunui. 




Aooordin}; to Tir. Wf.ukii i/lrr. i). X^iturf -Vf-rit.. IH12, p. I.'i9> many forms of 
oerronfl luthma, w>-di1]e<1, iire dop^nd^nt n})oi] a hr)>«r;emia of the tiri^ocliial inuuoua 
inembrAne, in consp'jneuce of nervous iu!lu«in<_'o. 1 have 6ifcn an old raua who hiul 
been tnaiij ji»n »exu:iJlj continent aj» u widower, and who. hnviuK maiiied apuu. 
•xpetieaoeil the severest palmoiuuy con^eaticfus l{prcat dyapnoea, cough, bloody and 
asp«eUn»t)on) at each attempt nt coition. 



The SEOitETioss become clniugeil in many ways by congeHtiv« hyiiertHinia. 
They mostly become more abund.mt, either from the 1x>^nntng or aftf r a 
lahurt dnmtiou of tho hv[>enifinia : thus that nf the »kiri, TniicoiiM niem- 
'hranrs, kidneys, sidivary glands, hiehryiual ghtnds ; the tiecix'tion of wounds. 
;The i|uahtMtive changes of the secretions are still little known: in general 
they a|t|ieai' thinner, as the milk dnriiig emotional activity i the urine 
•mefi movi: abundant and watery, often al^io albitiuinou!). 



^creased sweating in con.ict)uenoc of oollateral hypeneuia in alxo not iufrc- 

Ktljr ntxu in the uei^hborhooil of Lhe larger nicatrioBg (ikftcr deep liiiruN, eouflueut 
l-pi«). 
In the nkin. the arterial blood-eurrent divideB into three streame occnpyinff three 
fthuicfl : one for the idipose ti»nne. one for the Nrt-eat-^lnndn. and one for the pnpilttn. 
iTbe veins, in many places formm^ a oort of net-work in the upper enttoiiUr layer, 
'aic the bofrinubi^ of the collective vHub. whiutt cnnvcj the veaonH Uoud of all tlirca 
itilo^Ml-^troiunii to tlie KntR'ntntnums vvintt, iStHX)ntljry vaKnuUr loops from the }Mipil> 
-lary iitr«iiin mipply thn luiisniilnr app.imtnn, the exoretflr^' dactj? nf the mvnnt gliiiidH 
;ajud the nerv*?*.) Under (.-ortain ciniiitinni one or anotlier of these liloi^l-conrsca 
;in«y breome cloaed. If. t.g.. tlie skin i>f the pidm of the hand liucome* cooled, its 
ipapUlary layer fiUed with blooil. nud tt]«^>ro exutA an abundant and continnoas itecrc- 
Itum of KWeal^ th^re in a eontracflion ot the arteriex «niiplyinff the pupillaiy Htreara 
[above both of the dwper vnaonlar layent of the «ikin, while the blond -.itrearan for 
ith* ■ ■ ' ds and fiit an? not affected. The bloo«l iireijwnt in the v^nnn;* network 

;of III I/ hiyer aets like thiil of a di-ail bnuich nf the otht>r blood nrrcnms In 

•'•- I'ile the fenxt "f tlie p»pillar,v hlno'l-cniTL-nt Hink» fruni r-iiitnirtttin of 

■it of th*? «wP!ir j.d.iiulfl and ndi]>ot>(; tin.'^ne remnintt nndiatnrlicd; thtt 
I ■ I , H in the upiii-r c/^»ll*>'Ttive voim of the akin is flomewhnt incn^n^ed, the 

|Miflihar> ni-i.-work cannot empty ila oonteutu hito veiua. itti blood in perhaps dammed 
RiMk. (ToMS.V. ArvA.f. Dfrm-'t. u. S^/rfK, iy73, V., p. 1.) 

I Alhnniiniiria in (jritnuUr kidnt-y. wlmm nnmf^mnn Wi>od-ve(««©l« are obliU-'ratwl, ta 
lexplain*^ by the fact, that animal mnmbmn*"*. which nnder nioibTntf pn-Mnrf are 
"imperm*«ibIo to nlbinn-^n. nllnw «mali qnnntitics to pass throngh during an inf n"u»o 
[ot ptwviDre |e->Ilftt<Tnl hv]..>r<'inittl. (IIautli.s.) 

"Kot,!. ^Ei'KllARDT* If-(tr.. Ih;h found that after eeelion of the sptanehnies the 
(tim of arine iucrwued oonsideiably on the operated ride, while upon the other 




BTMrroMS or ACnVK IIYPEK-KMIA. 

Jlc it rnmnJnM unchwijfcMl. The Ughl-colorcil urine, in Uic first ca»e. shov, .1 .-r.lj 
F-<Ii^tit (Itmiiiutiim in thv iwr-cvur. of koIuI iuffrcilIciiU nud arva. The n{j|" .it:i-:i i. 
t albumen, an well a«i the ttt^xifnt ocuurretiue of un alkaliuu ruactioii. u not coti- 
[ifctcii vrixb section of the Hplanchuic nitrvo. 

li^IK-eittlly interostiiig in many Sf.iKAl.or.t; am tlio olijpctivclj"-flh^'-T *•—' — riuim 
'i^i.il (litKink'tti of btcixitiuo : in iieuralKia of thi- first brnticli of the tr i liiifB 

I occur redntiuM u( Uih coiijuncttvii and inenj:i«ed Incbryiiiatiou; In u^: , ^ .. .:' tU« 
seooatl brannb, »oin«ttine>> waWry or iuucouh Htiort^tlou from Uia nasnl mucons mem- 
brane ; in that of the third bruuoh, f r«<|u«ut Malivalion. 

DisTititBANcKS UP NUTRITION iippear only after a longer ilurmlion, or more 
fretjuent return of bypenfmia : die ve&aeU remauj lUlated, Ibc-ir walls 
gmdnulty thick*?n relativoly to their luiueu. By tbeay tueauts tberv arise 
not onty |M^rmanent cbiiuj^t^n la the circulation, wliit'h with reuitect to 
the cxisteiici: of tlio eulhiKaul circulation aru of grtitt iinportiiiKv; but 
also {lermoiiPnt nutritive diHt urban ces, which are shuum iiouiuLinios in phy- 
sioloj^i'o] by]H*rtro[ihy (in muscles, bones), aoaieiini'M art' of u )>uliiolcn;icai 
nature, as byjx'rtropbU'H of th« skin, boncs^ glaii<lH, t-hickt-niug of ibo 
art«-^rit*s un<.l cuntiuued (Iisturbiiiic« uf functtun, as, ^-ff-j i>i tji«^ bmiu of the 
intvnipcrnu;. Aa soon an true nutritive changes appear in liypfrn'Uiic 
parta, active hypcra'inia passes into atrophy, hypertrophy, or inflaiiuuatioii. 

A lar^ number of expr^rimcnlol ^cctioiu of viL8o-motor nerrcs have f>hown, that 
nutritive diBturhaneM in hyi>orajmic parts appear more easily anil qniokly in yono)f 
than in older aiitmaU; Uint tlivy nro Kuddeu and neverc inrenwly lut thn )>< 
part is protected from external iiijuriou" inducnocs (Scuikk. Snki.len. .M 
and othuni). Corrmpondinuly. ij-reuL uutntivc di<tturhaiiocH iu man aro piop>M i.'M.ai-.; 
Ii(cbt4tr, if ibfl fleoaoty and motor ner^'eji ar« panUyxcd nt t.bvi nunc tiim: with ili« 
vaso-niotor nerves; ai especnally in (wrt>re discones of t,U^^ ftpinul ooM and hmin. 
B«e also the bit«rv«ting oaite obsem^I bj the author, in UaSEL, Z. C'rMtfMC <i 
vaMiiwt. jVi*wr.. /Mja Thy. IMO!^, p, 10. 

Callatoml hyt)cra>mia in tlip vicinity of new-formatioua and the ootutcquontly 
increaaed supply of nutritive material, prolmbty in part oauae their qoiokar ifrowtb. 



Gkveral symptoms in consiMiueTice of ]iypun»inift ooeur only when the 
latter ia very extunaive : f.ij., in t)io heat of fev*:>r, when it aflVctH the 
whoU* skin, citlier iu burnini^ of the tiuiikce, or in {Uiriilysis of thi.> Aplancb* 
nic», when it atfects unwt of the utMhimiiml orgnna. Thi* (•unt'i-al synipt-unut 
have then tbHr orijj^n partly in niutMnia of other iuiportant organ's v^tn- 
cially of the brain and lunijh; |Mirtly in cbanfftw in the circulation (ilecruaw 
of blood- pressure, rctaidaliou of the puW), rcapirntion (dyxpua^a), U.>nii)«ra- 
ture (decroasc), etc. 

Phyiiiologitially, tha (fcueral coDaequeaoas of Hectfon of the ». »}ilitnehnM and of 
the uppur part of the itpiual conl are aconrately known. Aftftr SKiTUtN uf tlut 
former tHMiuutli the dinpb^^^n th-Te followtt a DKTUtiMiNATUtN uv hLihU) ivth TIIK 
AUKUMIS.lI. Vt^H^KI.tt, the ItLltoU rKKW^L'HIf: IS I.IIWKKM>. TIIK ITI-fF. Uf^4'uMKft 
QDICEtvU AM> i^MALI.KIl (ID conj>ec|URnou of anR;;iiia of the bruin, e>tpvuiitlly of diiniu- 
iiihed t<muii of tbu rootn of ifan vagi). The nmall aut] quick pul*« in innny on*r^ of 
acute gi-nernl peritdnitiM I" pntluility ttiui^ expliiined. Aft<-r HrH-tinti ui ■ 
of the "pinal con) there foU»n-K general dilatAiiou of th>? veaxoln and A<i:- < 
ptCMure: iit the aaiue time there ia a leswned frefiueucy of the piilsi- > {.\ i>>t n. 

Aftnr tixteuiUVe buniM of tin.* Hiirf jeo, Uiuri.* followa dilutalion of the ituptTfiii 
Tvaanbi with coiiHequcnti abuonnul mipply of bloml and clcvntcd ttnipKrniurc. on i" 
fme hand ; on the other band, tht; dilatation of the vonwN tmuM:^ n ilmiintitl"!! i 
tbo blood prauiurc, and Anally p3rftly»i« of tbo heart. Both expbvin the maimer < 
death from great bums, bettor than the earlier aK«umption of norvoiia collapse. < 
(Pai,k, Vireh. .ImA , 1871. LIII.. p. 27.1 

AL'trunling to UKlDE>'tL\tN, an iucrt:n>« iu the prdHBora of lb« aortic ny^t^m : 
^ liiiuiuatioo of temperature in the iut«rior of the bodjr i^pear through imtnt!>< 



PASSIVE hyi^i&£kta: its causes. 



183 



i BMUKiiy nerY« or throufrh diroot irritatiou of th« mi>d. oblongrou : the 1att«r eff.;Ot 
!■ dBpendent a^tm lui increoited tcmpemturi! of tiiu aurfnoe. Sets also Lev EN 
(p. 100). 

In later yean, n few ttpecial, more ur lesB obscare dL«»Mea hare been pro|ioM>d oa 
ccuscqaGOoes of a diiniuittlieJ fuuutlon of tha sympntbetic : Basedow's dimuuw* 
(Tnuuii^iiivu, Rt:M\K. Ki:cKi.iNunAr:*KN, Ouakkk. Gr,mKL). diabctcg (SciiiKr, 
Krc.). inWr.iiiUeUt opIiLlialmia (EUUONSTONK, KTC. ; Hiri.KN BKU'i-LAKUOIK). — 
Aci^orl^^nK t.j KtSKl. {Jj ArcM.f. kim, .Uat., 18«0. I., p. 34). the coalioc plexus and 
pouii-luoar gaji{,'iia, nerves Ipng in the nnighborhond of the oteiinc arterj', ait) 
kffect«d in yiwrbnn Aildintnti. In wmsoi|uouuc of tUia. tlio vaB» motor nerves are 
IKir%]jrz<Ml, tho abduiainai vea^ola are ovortUkil with hluod, wliilu all other Tcwehs are 
dcptired of it. 

O. PASSIVE OR MB4:nANICAL HVrBR.CUIA. STAGKATIOX OF BLOOD. 

(IntaroUon. VenouB byixtrsutnia.) 

pA88IVE nvPER.RMiA cuiwisU in nti iticnjjwod quantity of hlooH in a part^ 
l«^ss often througli ])rimurv decifawj of thr. gonerul l}loo(l-[ii-e8Hiirp, iiHually 
through iaci-caso uf thu resLjtAiicos to bo ovcrcoino (liiudnuioos to the Dow 
of bl<.K>J uut uf tliu vuins), or through both caiistM at the same time. Tlie 
V)loo<l th^n BtagiiHteii luoro or U-sk in the vt*iiou8 radicles^ if the liiiulrunce 
i^ not f|uiokiy removetl again, or if tht^ Mood duuH not find a hiUsnil dian- 
xiel. The latter is never entirely the quh*, and thus there i-eMdta a iiETAn&A' 
Tios OK TliK ulHorLATiON vichiu the hyper.eioic i-egion (ujtposed to active 
liyperaMnia, where the bloud current is usually ticceleriitcd). This ia further 
prciuioted through the greater extent of the veiiouH »y»t«ni in proportion to 
tbiit of the arterial. 

Tkx CAUssa or passive uypeo^mia are : 

1. Dei-RKase in the heart's ENERoy (mostly fi-oiu albuminous or fatty 
xuetAmurphouis of the heart), as it oconre in nevere acute diKe4Uietii, iu fevors 
«f long iliirHfiou {hi*etir, lypUous, pyieuiio, etc., fovei)»or, wiitiout fever, in 
muinisiuuH of ditTereut kiuds^ witUoiLt increase of Irx'ul resiKtHiiccs. The 
coTifeeqwences of decrease in the hoRrt''8 energy appi-ar in those places chiefly 
■wiiich are furtheat from the heart (huuds, feet, earsj, or in those iu wliiuh 
one of the follovriiig causes in added. 

O. Weber (I. o., p. O?) dealgnatca u isciutMic uypkilkmia thOHO arrcst« of the 
blood iu the ^eiaii after ri.oscnK of the auticriks sitplvinq tiikm, especially 
in inoompltte oollatnra) circulation. In the nlTecUnl cApiIlnn4>n aiid vein8 tbi* prewure 
oeaaea altogether with thu closure of the arteries, or ib coimidembly iliinitiitihed. The 
Teins are uvcr filled with blood, and with the cipillnrm^ are widely distended : then 
result cxudnliinui of the Horuin of ihu blood tFliruugb thu walls, hu;murrlmges, utc. 

2. DlMlNFTIOS or KNTIBE LOS8 OP THE TOSU8 OP THE VEINS (see p. l(»3-4) 
u hometinies found aft»*i- the operation of extreme cuhl or heat, as a coiiso- 
qiKince of Hevcti) iritlaiinnatioita of the wulU of the veins or of their sur- 
mnndiiig tissues, pruhiihly also thruugh disturkiuces connected with the 
iuiluuuce of the nervus. 

Aooording^ to PaLK < r»n;ft. AttJi.. 1?71. LIII.. p. 3T>. the dilnlatiou of the vcmbIb 
of the »kiu, which appears iu cunsequcut.'C of exteuniTC buron. U not congestive in 
character, but a reault of dimlimhcd cbuttciiy of the walls of the veaseLs and of the 
■urroiuidioif tiuites. 



* Thhi ihould be called Osaves' oisBAaE by right of priority.— [£d.] 



184 



CAC8ES OF PAS6n~K HYPtrBJSMJA. 



a. TsrRKASK OF LOt'AL RRsiSTAXcrES. Sncli cxUt, first of llll, in Zh(* 
clironic form of arteritis, which, thrau;{h its effwt on tht? inner cwnt, Lucrejuves 
tiip frictiou of the blood paasuig over it, and through tlioso on tJie mUliJIo 
Itivnr, (Hiiiinifthr^d eliisticity and conti-nctihty of tho vonst:!. Many hyi»«T«- 
iiiiH' and hiPiiiiinhaj^oM iii intlaiuod parti^, iu tumors atid tbcii* victitity, 
fI(?|H'iid upou this. 

'I'hi' riutnriil eiTecl of the difficulty is cliiplly on the vpiim. It upj^enrft m 
Jiooii «« thi! ninsrit-'s l>c*;oiue n-hixed, or aw only partially acti-T«. In men 
w}iu staiitl long (ty|MMi(>tleni, bakers), or who an; st^lentary (studcmts), or 
who lit? for a lon^; time (men with fractin^e« of tlic lower extremities^ sick of 
all kinds), it leads to flilatation of the vt^ins and, e^iH-ciuIly in ctxaeH of the 
last lUL-ationed kind, Uf iivposTASEf*. Tliuso »it' met with chiefly iu tlw skin 
of the back ami lii|!*i, heels, trochanters; in the ncrotum; iu the postorior 
and lower |)urtB uf dif lungs; souietiincii also in the back part of the brttia 
HJid spinal cord, btaddtr, prusUit^, ut«ruit; iu (he ponU'rior MUi'l'ace of the 
kidneya; in the d<>»'ply lying portioua of tiie inte»tineii. The** hr|Kwta3<4 
occur on both eides from coutiunons lying on the Imck ; in Uio ci<n->-Mpiind- 
iiig side, in prnLructnd lyiix^ on one aide. Ilypast-a&is of iho lun^s ih piti- 
moteil by the weakunjw of ihe reHpiratory niustjies, want of forei? in ihe 
boart*8 contractions, at>>ny of tJnt vaj^ciihir coata, perha]>a also by bloud- 
ch&ngea. 

Mciii1>er8. especially the Ctigcra, which are HtifT in their jnlntd after uM inflanima- 
tioMH, are often culoreil hlutJi^'red, aad arc tfahjcctivel/ aud ubjectivuljr coMur. 

ClIOKINO — <J0X(IEdTIO!(8 IN TIIK KTKtrTER RKHSE, tIY>'l!IL5:Mt.e OP VOX- 

PREBaioN, arise where a direct obstniction rendera difficult llie flow of 
venous blood and a Hiiflicient collateral circulation is not pivaent. Her« 
Udon^s (?oMPBKK.sioN OK riiK VEivs, f.ff. of tliojte of the ]i(dvia and lower 
cxtiyiiiitii-H l>y the pregnant utcruH; theftccuinulation of fctcal nia-ues againit 
the Inemnnhoidal veini); the action of all conatricting articles of clothing, 
cftpeciiilly in wnnten and Holdiera ; the aotiou of tmeses, of bunda of all kindii| 
of tuniora in the r-xirpun'ticJt; in narrow cavitimt, that of cxudatinua; iha 
cnu.sc<)uenccM of contractions of cicatrices, aft wtdl ext«<rni)ily in the ftfcin 
aa in the glantLs, as, t.fj., in grnnn tar liver, in the kidneys; of strangu- 
Itttiou in ovarian tumors; tho&e uf th^ intestinal veins in Rtran^^ubttol 
herniiL, of the ix-clal vuinii in pilen, elt;. Farther, the ftniuaticin of rxJAOtT- 
UATioNs AND * u:(L KKTioxfi IN TIIK VEINS; the manifold and varicose tiuhirge- 
iiient of the veins in the lower exij>'niitieit, in tin* wiuiiml c<jrd, in tht* privis; 
ill and around the uterus; uloerution of tlm veins; caveruuua dilatiUioa uf 
the veaseia. 



CoutractioQ of thi.< vniun pnibably alito oocnis in an tiii]c)wiHlent mannBr; at oav 
rate, wo knuw nothin*,' tr) the ootitntry. Experimental vxauiinniioiu uf inWHnil 
prsAsnre were made by ScnwtNiNUEU {Areh. rf. Ilm'U:, 18T8, XIV., p 800). 

Butne DisCA«iEfl tir Tiie urcii, nf the conniK!iive-tiitHU« and ruiniiininf; rt^ 
meiitH of tho fifw>ure,s of the Itver, of the tniitk of the [>ort.'d vein, arc fttllowwl 
by venous hypeneinia of tho i-adicles of this vein ; but which may, in part, 
l>e coinjieiiKateU for by means of uuastumoBes of the portal vein with oUnn* 
vcina, 

Many diseases of the ncAUT| ••■^p^^cially those in which the blood acctiiuii- 
laUis iu the left ventricle (iiiBufficiency of the uiiiral valve mul steuofcis 
of tlm left auriculo-vetitricular opening, etc.), a*id tluwo <d' the i.uxoa, in 
which Hither tlie nspiraiion uf venous blooil is lessened, or iu fiasssgB 



BTXITOMS OF I'ASPIVK MVTKH.fiMIA. 



185 



^lirailgli t\w |ni1mniinrk' vess^'U is ohHtniL-tol, liki-wisn Iirloiig Ut Uiin rlaKS, 
cLlthougli tli<'rel>y tUwo (iiml)y uium-jii-s h_T[H>npiiiiu of tlio wlinlfi vttiioiiH svh- 
^-c^iti. lu Uip citriliAc diiic;LHeH meiitinned nbove, first nf aJl^ ihi* tluvr of bluod 
out of ilie |niliiioimry veins is (»(mtnn_'t»Hl ; Pnrtlieron llic nrrfst is L*ontinne(l 
t linjugli th«* ptiliituiml veJiiK, )mrtly into llio bnnicIiiiU veiiitt (Kt^ncu chronic 
1>|-niioliiti/i), itartiv llinmyli tiii« {^i|ii)lHrit« into ll»> jmhnoiiBry iirU-ry, tli'J 
»-ight side of the heuvt, to the liver and through the rapillm-y systoni of the 
lAtt4.*r into thu alMluiuiiml cavity (abiloniiiukl hyjH-'r».'nuH). 

Aocordin^ to J, C. LkiitiIanN" (^I'nfrn'irhunffm dtn TihtUir>ir<kti> hri l\r*iMik-ntj\k- 

^■ritf^tt : liiht f-tr hurjn-, July, IHiTO, p. 1 ), the chnai^eK peculiar to blciofl aiivni ihyp^T- 

'Crojvhy and dilatation of th« ri^lu ntdt! of tho heart, cyano^ia of tho hvor arid kidiieyo. 

Ttutmcg-Uvet. hypcnemie tli*.t/)iimou of tha t-ploon. o.vnuotic coloring of the skin, and 

^ru|i«y) occur ofic'ueMt and arc iiii'^t luiiikM iii chronic broQchilu. wliilu iu jmliuoitar^ 

^hthiHJM Hi>i] flmpyemii tln'y are uttHHrvtid most nmtly, Tliin dOt's not dnpvtid nionttoa 

•%Xxe fact that the met^baniral niMtruciitm tu t\\p- paltnniiaxy ciroiilation !■ (FTcnt'-T in 

Ciliruuic lironc^tifi. bat apoa the Qfrfrre^nto i)uanucy of blood ia the bdly and in the 

'vrhole durutiun of the di^eoM! : the <{Tciiter the firxt and the longer tbu liu>t. ao much 

"tlvi tHionor. rrt. i^ir,, can c<>ii^tt)tjMri!< apgnrar. Kuth these last caoiKw an*, in clininiti 

'brnnchitiH. dirrctly favorable Co the developmnit nf a congcalion, il8 they cuii*«e do. or 

-no ooiutidQraMe. eniauiation and anajtnin, and UHunlly- laxt a vttrr looj,'' Lime; while 

K pbthisUi \a Moompsniod by (rreut emaciation and aniumU, uw) is ot shorttu* doratloa. 

I An (Special Dlsi-^JSlTlf'N" Ui vi'nous liyp'Tit'inift ia found in pyrtaiii jmils of 

^^tb** b<Hiy : in the hii'niorrhoidul veins, wlioso wttlls liave no valves, and 

^^^Hltosc blood huB to pass thixxigh ii st'cond capillar}' Kvstem ; in the left 

^Vpcruntiu vein, »iuc« it opeuti mto tho loft i-«nal vein (fi-»;*|uent cansn of 

varicocele on the left Bidu), etc. This disposition in HonietiineB aaptireU, 

e.ff. in the n*gioii of the Kaphiuioiis vt-in, from prcguiuicy, etc. ; soinetinieH 

hert^turr, «.•/. iu tin* hwiuorrhoiilnl vetnK. 

The 8Y3«iTOJ(8 OF P.v*8ivE HYPEic.«iiiA are gencmlly raoro lustinji aa those 

of cungciitiuu, uucv Iheir canHoti oi-c niuntly ct^utiunon^. Thev aUo, for the 

ui'tst pari, Bpjiear nmrvt hIuwIv than in the latter, and in many cjuwh never 

a^ain diHap|M_*.ir. They tioiiUy atfuct all the larger divisions of the body, 

,niic<> thM canitea, for the mast part, act widely, and siuco all veins freely 

•ABiMt'OiniiHe with one another. 

A DAHK BLnsn-KEU c:ou>R of the j>art (an extremity, tho Iip« and tnonlh, 
etc) tit th>: must striking syniptoiu. This coluruig in in eunM^ipnuie^ of the 
dilatation of the Teins luul t-apillanes, of the gn-ater accnniulntiun of the 
bluod- corpuscles, of the retarded ciixMilalion, and of the reHiiltii;g increased 
takiiig-up of carbonic aoid ont of the tissues. 

ConNnEiM ( ITrvA. Anh. . XLl. , p. 230). hn microacopfcal observation of the web 
of a ffQi^ aft«r li^aliuu of tbu oruntl veioii. saw tba arteries and vouia dUntc only a 
littlf?. tho ca|*illnne4 hardly mtmt than al>ant a fifth of th«ir ori^nal diameter Xuw- 
ever, aTuir loii^r duraciun of congenUnn, chore n[>pnnr8, aa may ho demonMtratvd in 
the vixibtc part* of man and in the dead, a cousiderahlu dilatation. In the Urer. t.g.^ 
thU may b«!come no conalderable that tho hepatic celU altufjcthcr diaappoar, or arc is 
varionB wnyit ix>inpr(mpw«l. 

C<inNnE.ni Haw thu hl<K)d-TUOTcmonta few acoondii after lifnition of the crnral veins, 

Come putttaUiiK aihI rhythmical : by tho Bnddon cloAore of the veius the reiUst- 
iu the veini and oapiUariea ao inoroaaed, that it was ovurcome only by the 

itole. 

CoilsilEtM farthxr ohsorvod, that after li^tion all the veweU brtonnie dentioly filled 
with b1o<>d-oor(iii«nlf(». (n the arterieH and Tciun tho charaoter of tho stream diaap- 
pMun, tbu blood -eurpiiMles come into immcdlato contact with tho inner contour of 
tlie rebel's wall, the red and whitu ^lobulett in confusion. Thin is utill tnoru ittriktu^; 
in the GHpiUariB« : the cjuoutity of bluod -globules 1>eoome)i greater with vveiy ^gtole ; 
tbcy lie at ftnit with their iong axis in the direction of tlie stream, bat sevn their 



M 



186 



EYMFT0M8 Or 



elVE MVl'ER^UIA. 



sarfacfiH are opposed to the Ktream. Their cont'mni nre ctill viiiible. After Mnie 
time, twcoty miuiites. the capilliuics appenr flllo-l with au alWj(Othcr bu-jio^oiieoiu 
lod «ubHULnce. iu wbiub only the uolotleu blo<7fi-globules aro still vieiblc. JitUa a 
nliiirtr titn*! tbiA olur bitcomeii bluuth-red. The moretniutC ii> ut the tiainu time cam- 
pleUsly arrcsteil. 

The behavior of the LYMPUATtca in con^a^tiTe hypenemfa is aiiU almoac anfcziovm. 
In the lower ^adi» of it. thc>- ore, ncounling to toaay iUdlui, trio.), ooiuddeniUy 
(]Uat>e(l ; in bii^her griulo uud later atagea, csp«iciallj if tlie poxtB ant drapucal, this to 
ourtiiinly tUo case. ( Viile infra. ) 

VThou congestive hyper:emt& extends to jiai-ta uf tliu skin luid to tbo 
finest veiiiB, whereby the skin, anU esfjociiilly the iiroiainonl [mvts (nose, li|«^ 
cheekH, fingers), mostly alsn the viaiblf* ntucuiu uieiahiiujeSj beuume bluixU 
ootoredf thuso parts are edited cyanotic. 

Ill n tutmiwcr BCiuM. by i^ncml CYANOSIfl, blnudl»euac, ia undonitoDrl Uio qnickly ur 
Blowly ii|ipciiriii}; KU*t«!, in which there nriM^i n uaifurra culorabtoD of the wbulu skin 
nnd tauooaa moiubrancft throu£^ a restriotioD to the interohonge of gat iu the laogv, 
uuil tbroDgb « retardation of the blood-stxeam in the oapiUarieB and wiuL 

A Lovrea tkupekaturc in ]uissively liypera>mic j^arta prooeedft, in |>*rt 
from tho sluwer cununt of blood, iii part from tbo iticomtiilorablc traiis- 
fomiatiou of muteml. It is most striking iu thu perijihoric partH subject 
to greater cooling olf, and is perceptible as well to the putieut as to the 
]>hyaiciau. 

If file sto^rnation of IjIochI takea jAtca quickly, the temperature of the part u at 
first ituireoHed liy m^-anfl of tho arterial Hnpnly : O, Webbb foond after ligatioa of Uw 
veins in the oar uf & rabbit, a riiiu of from 2 -3* C. 

Large h^emorkiiaoes upou free 8urfaoe«, or into the [Mircnchyma, usually 
occur only from free and delicAta vessfls (inner nifniiigRal layers of the 
brain, alveoli of tbu Inngs), or from discasod vcs&cls, or in conj^tive 
hypenoDua of high degree. ( l^lda II.esioukhaqe.) 

Aooonling to CoilxiTElM. thoro n|>[H^r in the web of a frog, at the earliest forty- 
flve ininutRH nfUsr li^ntion nf thn femoml Tt'in. at thn peripherv nf the capillaiiMi, 
regularly dihituJ ami fillwl with a uniform red ttulwtauoe |,the confluent rud .tilobulesi. 
muidl rouniK-d kuuLK of thu .Hamu c-olor, irhich swi-U out ui'>ro and nior.*. ptvatrnt 
Tounilcd vxcr<^i*oeiicott, and flutdly bvi;iiiii*> Urt;e, irri>-rrulur, uintren uitumoh. Thetm 
then fitll apart and appear fcn be cnm[»osed of rftd-g-lobiiles whirh now lie oat«ide ot 
the vessel. This tran-imigratioa of lihK<.l-corpmclc8 tak« place Jilw in some of the 
amalliMt veinit, when the atoifcef.'atian of blool iji especially ^reat, it is doabtfal, 
tlial the culorlo^ curpuiides al»o pasn throturh. Acci>rdiu(f to Bastixh (lint, JUaL 
J., l8f]H, p. A'2o), red ylobulnH. ai4 well a^ white, luave the Teasels in Teuooa atases, 
KorViatuH, etc. , by incaiiH of nmrpboid movemeutM. 

ViKCiiow {IJfifr. I. O'^rUeh , 1S73. I., p. Wl'M boa twon ohronic hypenemia exist 
with ruHt-coIored spota, nnJ lnt(>r m the doarl body tnic brown inilumtton of Uie 
lunjfs ill chlorotitf women without valmtar disea^j. 

Hlee'iin^. 0,9., into the reotnm, from thu noNe. act favorably on patiatve hypet- 
lomiie. AH well by the Ittcal sm hy the geuenU decrease of the blood-iuuKs. They 
may on thU aoooont also be reported to as tberapautio ineasnrei, as for axample in 
oongettion of the vessels of the bead. 

The rUNCTtoN of i^rts Is dimini^ihed partly 011 account of the retui-dation 
of the circnlation and of the little amount of tissue tranKforinatiims, puitly 
on account of the pressuru which the dilated eipiUarics exercise upon the 
surroiitiiLing parts (brain, glandular cells)^ partly on nccoimt of the dis- 
placement of other suhHtances, ?.;/., of the air in thn pulmonary vesiclei*. In 
tlie BKAlM there are pi-oacntcd sigu^i of depreaaion of the psychical, motor, 




SYMPTOMS i»F PAftflVE IIYPKR.EMIA. 



187 



nt] sfnuiry fuuctiuus, •liiliieHs, vertigo, airi-ctiuit.4 of tJie aonsea. In lbs 
XCUVES of the EJXCreiiutitM there i» a fcoliiig uf uutubness and weakiioMi. 
tE*lie number of iiEA-HT'Bi:d.Tti is uNually iLMsseumL The vufio-motoi* nerve 
ocniti'eA be-Cfiiiw irritatiul ; Hinall artert<:5« Couiract, bloi)il-])re8.suri} riiiHs. The 
j>a|iiU SUV ui^Htly dilatod. In the uriieues thoic }i])iH!jira n diuiiiiiHheJ 
crnjiAcitY for niution, nd wull lu thos<t of the ^^xtrfniitirs, &h in llu> homt; 
zb.1mo fur thtr luust jjurt in suioutti muMCular tihrus (tf.,</., in iiupactinn of tlio 
ijit«JMtiufH). In thu Ki!»»i*iitATOKV ouoANij ulso it givcij riso to slight or no 
Ijroudiitia atiil dy-HjiUfMii, whiclk Ht^imainii^ in a chronic luunncr lwconu-« 
xnofit severe. Tim (jlaxdl'lah OI((;A^'s, in which velocity of tho hlood- 
Ktt*euni and rapidity of excrotiou staud in direct proportion one to tho 
cjtlier, svcrute lesB, iht* i)nntttity uf urine L^ecunieA rodnt'od, tlie nriuf* more 
ooticentrmtod, of high spucitii: gravity, &1bnininonii ; tlie sedimcui, for the 
xnost part very fthuudAiit, couttdns uratas, ca&td, etc. 

If w« breathe Id as deeply u possible, and then with the g-lottla oIorM. hy moiinji of 
the miudea of cxpimtlou u well an b; ooaiprotuion of ihe timrax hy the ormfl. the 
greatent poi^ihlo prewnre lm exerciaerl iipoa the Uiiitftt. the hiiarL's iiiij>iil»c aiilI tone 
and palm- gnuliiAtly btKronie we.'ilceun<l, and niuy «ntirt.>.l;r iliHupiwttr; Ih^uervical and 
facial Vfinft ))t!coin<3 swollen, tbo skin and tini(x>un tnembrnnea of the hfUtd become 
bloiBh-retl. fcUowod by dLuiues!! and even fitiutiuK (Bu. WEBiiK, Do.vpkus). 

Aiwonlinit to L.v:?Doia (MM. CtntrnVA.. 1807. No. 10), hyperuemio states, eapeelally 
renoosHtMU of tin- medulla nbliin^^ata. con give rUe to ATT APE'* of KriLEPTIPouU 
co.svtri.«iONa. ITkiimann and K^ilicu {Arek. ti. gcti. l*hifitiol., 1870, III., 1 U., p. S) 
baT« likttwiM BbowQ tiy Qxjwnmfuitation on oats, that tho Hame couvidiiiunK occur in 
diminished a« weU ua in iiicroawd euppl/ of blood in the brain. Hence, the imme- 
diate cauae of both forms of convnUioDn is the nme. namely, a want of oxyj^eu, 
and the accumnlation of carboaio acid in certain rogiouB of the brain. Acoucd- 
ing toXoTHSAHKl. {Voi.HM.vx.N'a Sim/iJ. KUn. Vortr.^ IH73. No. ;10), the symplojnB 
at tli«> bx^inuiiig of nn epik<])tie nttacic (coma and ^nnnd convn1<*innx} have llieir ori- 
^11 ill urtpriol luuRinia of thn brain, part4cQlBrly nf tbn ponn, and mtidnlln nhlnn^ta; 
while those appearing late in the attack (coma, gBoeral convaUioua. hi^h di^ree of 
Tt^nijuahjpmaniia of tho face) prooeod frum TtuiuuM hypf^nuiuiiL Tbu same irritant. 
<ir)iicii acta upon the oeutm of roitfiiracion in tbu Hpiiiul cord, iucit4M to Inoreaaod 
activity all neighboring ccm.reiicoii<:<?med in an epileptic attack, the automntic centres 
•o-callud ; the vaao-motor centre, the centre foe conmlAions. the nuclei of th<^ cere- 
bxal motor ner^-en. 

Wliibt most fuuouuns are diuiinuthcd by vl-uoux hypenumio. a motion appears in 
nnt>otb miiiwulnr fibroa. Aeoinlin^ to MKVElt and BAurn [Oi^jitr. Jithrb.^ 1871, p. 
14'3t, Ktnseit of blorxl in thn intestinal ennal escitu ttti muHonlar filirefi to motion; 
" dyttpmoa of the intcfitincs cause* their ooutraotion." In the same manner conges- 
tire hvpcnemiais thecauMof moTcmenUintheutcnu(Osi[U and Sciii.ehimoeh, tide 
p. IHtt). 

Watkrv TRAXSiTDATioxa arise vnry easily in parts which liavo long been 
subject tu venons hypt^niMiiiji. They apjieur in orgaiiK of large Knj)er(ifial 
oxt4:nt (skin, etc.), ami in Kcrous cavitie.s, as dropsy. In tlie nincoiLs nioni< 
liituK^s Ihcit; up|K'Ar cHiinxio cATABniis, H.S most ufleu atfect tlioae of thfl 
n-spiratony passdj^os and digestivt' tract; hei-o the unumalicK of secretion 
•re vtill vcty olMicnre. 

A utodi^mte &WKi.i,)Nu of tlie pHrt is fret^neiii in venous hypenomia. In 
exttirual parta this ia easily ttemonsti-ated, lu mtemnl |>ai-ta only in tho 
liver (eajfecially in Insufficiency of the mitral viitve). It in aoinetiiiioiipuiii- 
leiit», Botiietimus ooiiutiuted with a sense of weight, ur with a dull paiu, a 
fnt'-ling of liglitneSH or uf prt'usuro. 

}*iU>Miv»! hyporjertiia of very long duration may bo foHowod by hvi'EH- 
Tnni'HV of the dihit^'d vesjiels and of the tiasnes themselves : tho former, 
niuHt often iu the leg In vuricciei, also In tho niiua ; tho latter in the con- 
ni'Ctike lissuo of thj slcin, niucoua mumbraueS| glands (cyanotic induration 



1S8 



TFIROitBO^IS IXI> ITMBOLISIT. 



of tlie kidneys, etc.). More freqnently congestive hyperwinia give* rise to 
ATRorHY, «.//., i-eii atrophy of ilie liver; not iafrwjueutly, however, the 
iliiKumlion uf (b^ pnrt is coiu'eaUnl by i\ie serous sweJIiug. U.UiGits.vB 
[tftrflitfnt'ts) arJHfis mostly (miy fr'^iii t^xtfriml jn*w«ura {in the regiou i»f lh(> 
hip-H, etc.), or in totij m-rest of ihe circuUtioii. 

UuNEKAL }{YMPTiiMi) Kebloin Aj>)ie4ir in congestive h^^*peneiuiii of single 
partH of t)w l.">lyt but VHry oui'lv ici noiiHeiptenpf* of gen^ml (tii]i>mia, .■uid of 
tlie lowering of the blooil-pivjwnre, which, «.;/., is present in over-6!ling of 
the poi-tal vmii nnd its ront« (oxpfrimentally — in convulsive stnt^-s ? in 
prcHsuro, etc., upon thiii vcsst:l), or nfter bums of ihe skin of large extent, 
producing dilated tossoU. 

BonDAERT tBitr. dn bull. A* l-i toe. df to^I. tfe fJnnd.. 1973). by li^tioa in rabbits 
anil ^tiiii«-ii-jiii;« (if Ixitli HXtonial and )iit<-TniU ju^Iar vfiuit. uhI HimultAiiuoiisseecioo 
of iKHh cprviiidl syiiipatbetiM, prniluopd n not inrfonsirifirible exophthalmo*. which 
exiatttd many Aay*. and A^in gr»j1vially (1Urip(>vared. with the ostabli^htnent of the 
collateral druulution. B. ItftaUKi iiIad the inferior tbyroil veina, followed by owelliuy 
of tbu thynii.1 );Liui(L B. holJii Ibu ^^tval acc:uIitmtiDn of tba bearl'ri ottauiicLioaa, 
from pArjkl,r»tm of the cervical symp-'itbetic. to be the primaiy condition of B.vstiUovr's 
ni^e.v^K. thron)!:b whiob contraotioas a anfBcienb emptyinj; of bbe veuu daring dtM- 
tole la prevented and k venous ooogestion \» prodaocd. 

When the causes of %'enouB congestion qiiickly disappear, there ap|>e;ira 
in a short time a RG-KST.VBiJAlfxsNT of the normal conditions. This niay, 
however, alfMi take place if the congestion remain loiisfer ; the circulatinn 
iigain btoomea free, first of all in the veins, tbeu in the cnpillurie^; the 
exuded serum dijinppears from the tisaiia'^ tkroiigb the lymphutici, the rvd 
blood-glribuli's partly degenerate into fat, partly enter upon a pifpneutary 
mutiiutorphosis. 

CouHiiBiM, ia bis exporimonta. Raw, after rcntnring the corroDt of the blnotl l^ra 
movrU of iU obstruction:*, t-he homogeueonm red uummdh (coutlu«at ro>l-{Mirii°'*<^b:«} 
tomotiinus in a few minutes sgain separate into their individual normitl elements. 
The retl'glohnles found conliuvd in the ve»t«ts* walU in their paasn^rr tlirmi^^h them. 
partly p.i8se<l ou to the oxt<;rior. whilo others wore broken off by the bloud-rtream, and 
are earned ouA-atd. All were (foiiu in from bwelre to sixteen houn after loowenJag 
of the lit^Mirc. 

According Ui On VON {AnA. d Phyn , 18ft9, T., p. 5<1]. t.he palw in the carotid ooo- 
nol be felt, dnrinfi; ntmnff intiKcutar efforta. as la partnritton. whiln that of the mdnl 
ovotiniiofL CJ. oxplftiiw ihiBby a swoUiog of the thyroid ^biiid ifroiii voonits i«>n;5ei- 
tion) and a simultanoous contrftuCiun of the niustelcs of the ne>:Ic. ko thnt the ooratids 
are comprewed by ihetn. In this manner veuotu uong«'<tIonA in the b»ad ami brain^ 
threatening danger, may be checked by a kind of self -con trolHng of the nrteriml 
supply. 



3. THBOMBOSIS AXD EMBOLIBU. 

The (drier researches of Wcpfer fUi??). Goni. (1710), etc. J. Hdxtbr. TV. ^ « 

&tr.for thr Impr. "f Mat nnd Chir. Knnipi.. 1793.— HhHoson. Toh ./. Kronlh. dL 
Arft. «. VtHfiu Tranfil. by Kimikhwkiv. 1317. — Ai.inr.RT, /frcA. n/r uh* •T-VfiSMi 
ptui fonnufda r<iiuMtHT arUruU omiiifferi/' foimnt musi' d« gangr^iu, ISS^* - l-'i. . •«.. twi^ 
Ea*. K'lr Ut 3*ingrenf tpontnnec, 1^21).— STri.Lixa, Die OMuihj m. J/ .f« 

B'-utpfi-ojifft u. ». 1/1.. 1S14.— STAXsins, f'rh. d. kntfikh. V'-mrJdir^. ,■/■ . ,t- 

mtjtt'iiHVit', lH:{i).— OULLIVKR. Mrd.-CAtr. Trnnn^rt., 1S;i9.— ZwjiKV. D' X 

dr» Tht'tiihut. 1841. — TlKnKMA'«N, Von d. Vfreng. n. SrftUfM. dfr i ia 

AV-^miA. 1813.— Paokt. {.-inl .Hfd G./f., I8i4.— Porta. />f/^ mVr.n- ..'f-J 'IriU 
nrt. juriii Ugitf. t> laUTn.. 184'>.— U tME. Zt*thr.f. r<\t. Sitd., IS-l'l. p. 91.— Viarnow, 
Zt*fhr. f. r,it. Med., IH4fl, V. ; /V**-.'- .V**^. I8W; 'I>,iufH-'n fi^itr., |H4*i. 11 . p. I ; 
Ar^h., 1.S47. t. p. 373. V., p. 37:.. IX., p. 307, X.. n. 17»; ^m. AM-t>.'U. pp. .J7 o. 
819; Hiifi.d. P/itA. u. TArfr., L, p. l.>6.— Meimbi,, ^nrA././)Ay*. linlJc.. IS«.— Bicar- 



KiritOMfiM. 

»rwT. JfoHiMjf Jotirn., ISSn. — 3kxii. Kirke«. .Vrl-CMr. Tntfunel., 1S32.— Rrnr.ir, 
\'irrh Aivh., ISTiS. v., p. I-*).— Top-pSKLL. DufA. Qwirl, J,mrn., IKVJ.— KUNfiF.R, 
^trrft. f. phf/». IfrCli., 18V^. — Coils, Df rnfuJia rjiugrtr iifq\uii», tHStl; fCtinik firr 
mraffPiificfifH f!rfriii»Kr>tnkktHfi. iRtUt— Di'-t'Jll. FJ.»C^tr. f. rnt. Me<l,C VII.— t'ASU;!, 
Gun^fniyg^ Zurhr.. IS"i((. VU. ; Virch Arc/i.. XXV.. |)i» .'108 aoil 433.— Ukckmass. 
>VfvA Jr-'-A' . I8*)7. XII.. p. 3a.— Scn.'^ZKSnK«uKli. O.n. tit^4. tie Sinii-'M'ir<j, IH-"i7. 

Frommiss, Virch. Arch., 1*W. XVII.. p. l:tj — Oii*KFB. .1%. Witn, mc<L /.<:!.. 

1850. So 14 — O, Wkhkr. ni'f. i1. Vhir., IHTi. I., p. Qft.— Voi.KUANr^. hjugrnhtrJc't 
-rlrrA., IHtW. V.. p 3:«).— TlirEUsrif. fci P^tha-BUruUt'^ ffth. rf. TAir., Ib«7. I.. 9. 
Abth.. 'i. H., p. r*:tt.— Conxiitciu, L'nten. &b. d. emboi. Proo., 1^1%. (Conaijlt alMt 
^be lilerulure: ul Pv.BUtA.) 

From vAi-ioiiH luoal bikI general causes thova ooonni ouRi^io life, viUiiu 
tlio vfJiHol-!, a t'OAGUL.\TioN OF TUEIK (*t>STKS'rs. Thu oougiilutn la dirttill- 
gitialiiKl from that arisLng ihiring the aftouy, or imiiiediaU-ly afKtr dfiath, by 
the ifvta TnitoHnt'.s. Such a coagiiUiion onw having taken ]tlacp, tf.ff. in 
tho veiiis, the wh'de channt'l may btfcome ohfttructed, ami the procosh oon- 
tonne peripherically into the &nmlh-9t brna'-'hes ; it pi-ocewls toward the 
centre hh fur hh thu nF^m^st hirgt*r iiioHiMiliitiug lirancheK; th() vtMigviluiti 
proj<^cls somewhat from the motith of the vein, un<l nIiich the bh)o<l-sti'ciim 
of the other vein l'oiiu'.s in fui'ciMe cnntaot with it, here ai'iMia a throiubiis 
which may agiun extend backward iuto ilie distribution of the sucoud 
vtiri. 

But it uot infrcijuetitly liapprna that the Id ood -stream euni-aing along the 
five iiQobstruvtoU vesHol, couic*r in contact with thu projucting part of tho 
coagulum. and cairien a piece unrar along with it. This may alao ocrur in 
a co;iguIum which does not coruplettfly obstruct the vessel. These free 
conguta or pipces, if they belong to the veins of the ayKlt-nuc circulation 
whicii do not open into the |mrtal vein, must piiss the right side of tho 
lieurt ; froni here they go into tho Iinigs, and arc, according to their vohnne, 
drivtm into a l«rg»'r or dmallor bi-auch of the pulmonary artery. If they 
bave their origin in tlie roots of the portal vein, they are caiTied away l>y 
that Vfin, and stick fast in il« he|N»tic branches, etc. 'JTua occurrence of 
ol>«trncting vc9.si*lri by ccuiguLi wliich bave been trAnaportdl from other 
partu, i» (^Ifd UMUOLiu TUitOHBOsis, or KUBOUSU. llie obatrucling plug 
Itself ih cnlh.-<l EUftOLtTfi, 

The throinbiLH and tlic euiboluH &»;, in the greater proportion of oase^ 
congula of bl(>«>d; both nuiy l>e formed of other subsliuicuH. Tlie coiuie* 
qti*'nce, however, is then almont always a coagulation of the bluoil, for ih« 
oio&t part around the priouu^^ thrombus or embolus. 

A. TUBOMDOaiS. 



TTnirtKBOSIS, i.fl. THE CO.\ntTl,ATIOS OF THE BLOOD WITHIN I.tViXO VE.S8Et.S, 

follows tho same laws aa coagulation outsidu of them. ( Vltlg p. 155.) 

Tlirombosia occurs frt'iueutly tn the heart, in tho arteriia and in the 
% •.'iu>» of medium size, Beldom in the capillaries, oftencr uguiu in the lym- 
pliHtich. 

Ax AirrocHTHOSoiisor pbimitivr thrombus is one which remains confined 
in the part in which it first iit\Me, eapcoiully in tho heart, aUo in the vessels. 
It lie« in contact either with the inner Kurfiioe of the vessel by a greatly 
varying extent of Hurfao, without sensibly contracting the vesacrs channel. 
(>r, it jirtijecta Hirther into the chanin*l, ao as to effect a real narrowing of 
thu vcaset : so-edlled I'ARTIALLV onsTUUvTiso TiiuoMUis, Or, RnaUy, the 
ve&sera channni, to a varying length, is oontplctely cloHod by tlie coagnlum: 
»ocalled TOTAU.V obstkitctiso THnoMBis. Tho sha[>e of thia thrombus 



190 



TtntOMBOglS. 



coiresponcU exftctly with that of the vessel : if the latter is large and pouch- 
sliajK^d, tht* former will bo globular; if branched, tho tlirombiis UkewiBe 
will be hratiehud ; bub itss cuntral |>art, i.e. the uiid directed tuward tho 
hf^ri, always takes tho shape of a roiuiduU cone, in the arterie« na well lu 
in tlie veijis. 

A iMtOGRKKSiVK THKOMBUS 18 oue which growB continuotLsly through a 
variotm uxietit uf the vtwwwl, Avliich, fi-oiij kiii:i11 iMiginnings sehloni procwNii! 
qiuckly, but for the most part slowly and by uirata. In the art**!-!*?* the 
progrpsH is oftoaer from thi" trunks and larger branches toward the siiiall«>r 
braiichee, while in the vdins the contrary usually uccuni. Ittf ext^^naion 
takes pUce in different ways, fir^t of all, always into the next hii;ger col- 
lat«-al branches. 



Exception!) dccnr in tho reins on acconnt of the oaay eompresBtbility of their walls. 
Thus, in obstruction uf tliD rirht iliac veiu, a very lou^ plnff in uauallj farmed in tlto 
vena cava, while oti tht< l«fcaide thin rarely ocourn, b*canae herti the ngfat iliac aneiy, 
croHPiing the left iliac vein, favore the olosnre of ita orifioa. 

M'wt of those thrombi are called sbcoxdabt which arise after priuuiy 
inflammation of the vesijels or of the tissues ioimcdialely anri-ouuding theoi. 
Many thua designate thoHe also which are continnons from n ve-ssel into 
one of another kind, e.ff. from capiltarica into veins or into arteriett. from 
veiiia inti> arteries, etc. 

The coagulum is oontignonn with moat of the circnnifereDoe of th*? vesw*l. 
Leas frec|uently there are fuuud between it and the wall, spaces, whieh are 
^IihI with thud blood : tho latter come.^t fi-oiu the small veswts which enKr 
in nr depart from the ve8M;l at this point. 

The rHAHAiTER OF THE TniioMBU.s Varies, Its surface is aln^ays smooth 
and even, if no especial influences huve acted upon it. Thrombi auk or AHE 
KOT LAMINATKD. The latter occura from Kudden coagulation of an »rr«.ted 
mass of blood, e,ff. in ligation of vi-xsc^ls; red and white hlootl-globiilea are 
uniformly distributed through it. I^tniinated thrombi arise during a slow 
and continuous coagulation with au intermitting force of conden&itiaoi: 
they show in tratmvei'ae aeetion coli>rlesa corpusi^lea in large quantity, and 
alternate layers of red and white hlo'xl-globules. Tl\e layers aiv not |>er- 
fectly eoncentnc, hut nro arranged in longitudinal and tmnsveme aoctton, 
like those of an inuoti, if the thrombus is situatiil in a bi'oad eAvity (heart, 
varix), and the lattiir in attachwl t-ii a small point ; or they are lik« thoKe 
of the juirtN-^ling ntily in croAS section, in longitudinal section cousiftting of 
overlying ellipsoidal layers, if the thrombus belongs in a narrow vessel. At 
first (he thrombus is dark- or grayish-red, elastic, aoit^ moist, and has a 
smooth, gliHUMiing, niuiist surface of sectiuu. t>rni]ua11y it Imcomes paltT, 
<lrier, lesM elaatie, even crumbling; its surface on section bocumes dull and 
InstrcIoKs, and is at ditfereut ]K)ints colorevl red, brown, gray, and yellow. 
Under the micivisoope ihei-e «ro to be neeu (ibniuM lainelhe in tiicuiisidenible 
number, ami between tht*m shrivelled white au<l red hloo«l -corpuscles, ehicMy, 
liovever, albuminous molecules. 

Thrombi arc not to be confounded with the CQafpiln found in the dead. Ai is w«U 
knoivn, cou^ita arc foanJ in almost every dead body, in the right ride of ttie heart, 
when the dc»th-Ktru;*-*k- hiut ^jeeu prolonged TheM are lit;ht. or dark colored, looar, 
elastic, twft, and aro nttaehed to the valves and Cfird-i. Tlie ilark ooaffnla oraisi* of 
flbrin. njd and white bloodHnirpusoles, Frerjnently the mi t'iirgHinclcB tfuicklv muk. 
leartng the coit(*nlmn formed only of flbrin and culnrleas oorrmaclej* ; it then a^jwan 
white. t>r w hi tjah -yellow. The«e oo^iila reach from the riffht side of tho heart iuco a 
|>ait of the polmouaty artery, but which they never entirely TiU ; tlioy aie ooutiunoos 




OHANOKS IN TTIKOMBI. 



191 



into tbe Teas cavse, and llience UtrODgb ttii the veins of tho btx!;. into wUob ttw 
Ijluod, at the tU-ath of liie visMiht, U drivun by ihu (^buitacily >•! the urtcrius. Pwjfllt 
Htc uitl u»uklly foiinfi in th>^ artonoM, ur oal.v funali iiqca in thoHC of the Uirgvrt afte^ 
arttmiljir to thriM; mptitionrd ahoTft- 

Th« frcab, lamioAte^l thrombus in dUtirgnt^bed from a simple hlood-coagnlum : 1, 
\>jr ita laminated fltmcturc. which it- prc«cut in almoHt all somowbat thicker thrnmbi ; 
S, by ita ifftiatcr quoutitjr of tibriu : hcuce tAn^e thrDmbi aru mfwtlj Iigbler, bnniT, 
&111I driut than cua^^uia; >{, by thtj greater pii)jK>i'tion of w)iit« bl<Kxl-corpiiM.'l<!S ovtfr 
^Uat of the rn(l, wliich pn>cui'ds in part from a n?Lar>l:iHon nf tht; nirciilatiim, in (Jitrt 
Irom thp fact tbnt tlit- Ulood of many ftffeoU^d with ihrombo* formation i» richer in 
«n<^h rorpiiir!f-.i <thos(? nfffctcd by piierpemi dineoHOK. and POTi8nmptiv«>t. The non- 
lai»inat4xl tbromtiiiA in, in iCft most rcoeut ntate. not t^> be distiiigulsihcd fromn blood- 
coAguium. Later it is cfaoraaterixed bj its motamorpbrwea. 



Ttie FAKTHKit tiKSTiNY of ti THHOiiBus A ariea. Most important aru ha 
purifdriii lii|iipfii(:tion luul itn nrgiiiii^catiou. 

PrtiiroRM LiQi-KFAcTioVj or NOFTRMNa, in tlio imtiikl nintanit)r|ili<t!Ufl of 
laniiuatctl thniinbl of the lutni-t luiil veins, in thrombftsi.s of long iluration. 
Then there in found, nt timt in the niiilclte of itie thrombi antii extending 
thence t4>wiii-d tlie peiiph^ty, a li'iuiil at frnit Hliaiply cif-'iiniscribtMl, Inter 
morn ditfuso; nt lirat raowi ^tscovip, tlipn nf a thin or thick conwsU'ncy ; 
-Which liquid to tbt^ nukfd nye Honiciimcs perfectly rcBcmbles pure pus, and . 
- BOiutJtiuies has an ichorous ehanict^r (reddish or bn>M'ni-sli, thin aud often 
of ft disMiijrnpablft odor). At the beginning thpr^ aix; mixed with it crumb- 
Uu^ [>ArliclL--ti, wliich aro the reinaiiift of the moi-o dense librinoua Jayera. 
The naicroscopo then ahowa, in such thrombi, the tilements of true piia only 
•If pus lm4 perforated into the vessel, or if in it« wall even thore h^is hap- 
pened the f\>rrnAtion of an akscrsM. UkuhIIv nlbuiiiinons nioieculea are 
chietly found, Liter, oil-drop», rod and e-.s|>ecialty white blood-corpusclcs, 
nirely nnrmnj, but mostly in a state of metamorphosis. 

'nu'rtinj.isi/,ATiosoftliromhuBOflciivH mostly in the non-laminated vanety ; 
less fretpn-ntly in exteniuve thnunbosis of the vein;!, with final doHtniciion 
of the channel of tbe vessel ; more often in purtia.1 thrombosis, in the veins 
as well u8 in the arteries, occurring especially after section aud ligature. 
The thrombus lilling the veMsel (artt^ry or vein) imniediau-Iy wfter injury 
rmicliefl front the wounded point to tbe nearest eollateral branch; it is 
accordingly of ditferent lengtfia, and on one side (or on botJi) projects into 
the bloo<i-rttream with conicitl extix-JnitioiS, It is already, very skxiu after 
ita. fnrniatiim, firmly eonneci.eil by its base to the inner surface of the veiwel, 
wliib; the remainder lies at first loo».e in the vesnel, and only gmdually 
ac4|Titres a Hrni connection with its internal Hurfaec. The coaguluui is at 
first durk black rcti, later of a brown i-olor ; in its farther i>rogivss it bt^conieo 
jialer, always lirat in the centre, until after a few weeks or moiUbH it H.ssumt;s 
a color similar to that of tin? vosgel. In tlie course of ths ft)llowing weeks, 
iu tho thicker coagulation of tho following months, it always shrinks more, 
BO [hat the vessel en<Is in u coniail form, and blind, in cJaitrieial tiHSue. 

The views held coneerning the mode of nrgantaition of thrombus ai-*' still 
cHWdf-*!. It certainly does not take plnce through free exudation ; probably 
as little through tho colorlnss btood-corpusclea included in it ; perhupa, at 
leant iu part, through tho colorless cnrpuecles of the circulating blood, since 
tJiese piiss into the thrombus fi-om the lutva va«OTvm, or through the colla 
formeil outside of tho vessel, which cells the vessel takes up. The organ- 
ization of Ihrombus takes place moat prril>ab|y, however, thiough the entlo- 
thelia of the vessel's, as well as through the connective tissue cells of their 
iiiciina. These grow witiiin a few hours, and are transfnrmed at lirst into 
spiudle-iibajied cwlls, later into counective tissue aud veesels. After sevea 



102 



oRGAinzATio:? or tiisombl 



or eigJit (Inrs the tliromlnis, osp<K:ially at its poriplipry, is jinnelmtt'cl br a 
nnt-woi'k uf yuungcu[ii]lurif.s, wlucli in the fulluwtug <Iuts becume murvand 
more ntnnt^t'oriB. In tLe meanwhile the bluotl-corjiuwli^s are iJt'«tr*»y«Ml, and 
likcwitH-' Uu' Hbi-in, an iu Ibc innifcirm li4ut<fuction of llit-onibuN. Tha newly 
formed vessels uf the thruinbuH iinil of the iritiniu of tbo vl'<wm*1 conto iiitu 
eommuiucutiun with thy ori^itinl vt-ssols, and with the nowly-fttrmeJ vpsbcta 
of the luiddlu coat and advctititia, and thus arises a true circulation through 
the thrombus. Later, tlinre ajipcars aJfw n coniiminiratioii of the vefcseU of 
the thrombus with the chaimel of the vessel contidniDg the thrombus. The 
fonunr talccH place etirllest at the constricted end of ligated vesM^ls, H'here 
the CHlluUr ooiiL i» draivii ovi>r both the inner coatA u'htch are etirlal hn- 
wji,i*»i, itnd w|»-ii ihe bi-eat-h in the ciMitre closed by ihe coaguhiiti rfiidere 
iinnioilintely (wssible the inwnnl growth of the v««ReIa of thn jidvintitia. 
Thus, after fwur to nix wfeks, a complete circuhition tln-otigh the thi*ombu5 
is established, and iigntii giiidunlly rt'trogrudrs in the following manner; 
the i-OHBets again diHajijH'ar, the primitive jelly-like connective tiFsu*r bcronica 
more and more deiisf, tho red blood-corpuscles and (ibiinoua dotriturt Jrtill 
present are renbtorbed. Fimdl-y, then; femaiiis only it snuill connective 
tl^iie plug, jtoor in vessels, which finally :iiiiy li«Ht>iiie so shrunken that it is 
deniuuHlrable only by the mLcroBco|>e. 



The orjpuiization of thrombus wna demoniitrated }iy tho older DbMrratioiui of 
HrNTP.R, Bi.A>{DrN. LoB^rrBtir, Stk.lino. and jSukkv, by thou more recent of 
Btl.l.KOTH. O. Weukr, Thieusch, Wai.devkr HinsoFF, etc. ; or w«I1 from oostul 
obsorvatioiiii in iniin, tui in the uuniw of otpehnirtnt on iirtericK and ruuia. That it 
docs not take pl«o« through free (ixnilntioa was shown by Vinuiow, O. WrjucR 
(Hfir't. I'b'n. iFi^r,, 1804. N'o. 2-'if iufcrreii tbnt it was brought about t>jr means of the 
colorleaa hlnod-cnrimsclM of ihr t>aromljUK itw-lf, 

BiiiNoKi' I A/t-I. f'frfM.. IS«7. N'o. 48. oud l-'irr/t. ArcJi.. XLIT . p. 4^12). in a namlwr 
of exj>erim<^ntn, fnund thnt t>]p contmctile colU which arc formed nut)«ide of the 
veioft take up cioniibnr, peiieLmtc th« wall of the vefn«. and bv their gradunl mi- 
gration riiially come luto tiie interior of the vetu itnelf nod reach the centre "t tbe 
throtn)iUK ttciHiiiK from liKnture. From u at-cund Miries uf uxperum:iil«, iu which D, 
Inject-^id i-innalnftr iiit«> the blcxKl from tw.'lvc to twunty-foiir Vrntirn »if(*T the 
cittahh'Bhinpnfc of n thrombuFi. it B*M;niMl tn follow that the r*illR ■ ibnr 

within the cin'oliitin^r bloinl penctratiol tho tbrombn^ from the 'b« 

wbito corpUftcU'S btiUffijjinff 1o thn free circulullou ihiift apiMUircu '•.•• '•■•■ .■■■■.--nted 
to a elitrht dot,-rc<; in thu orgrmization of the thrombus. From n third scrieji, in 
which H. inJBCteii cbumbftr iiito a tbroinbufi ariJiitig from lig:itiire. lie condtutu, 
that th«? cuhiriiws blood •cor)inHctfl!i of the ibrnmbuH Ioho thyir powur of mif^ratinn, 
and do not iTortH-ipat*; in the cell-fomialion connect^Hil with thu tiiwuo of orffoniM' 
tioii. n. o<Mil't not purcedre that the cpitholinm of the Tejos aharefl in the cuEguhB- 
tion of thrombus. 

TuTKliArn, nod W.iT.DKTKR 1 Vi'irh. AivA, XL., p. 37!!) demountmKNl, iudfciwnd- 
entlj (if t^;icli ot!u;r, thai the uudotluiliura of thi* ve*»cl phivcd u uliirf r.'At^ in the 
Oifi^nnixation of thromtnin. Aooordinj; to bhu Intter. thn.imbit« in orptni7.f.'%1 Lhrcmgtl 
iaorenue of the coonectix-e-tiflBue cells of the veMel-wall and of tb'- fndntbeha! o-Iis 
of the vcinK, Thu intimn apjiean eli^htly clouded, as if coTor'sl willi n Hiio doiA. 
Dvlicut*: attachracatfi ure then formed, which Bometiinca ore ftucly papillar. some- 
times vclv«ty in apiwarnnce. The fornintioa h a iK:rfcc[ly oiv,Mii£e.l. pcrfectJy wft 
granulation tiKRap. flonsult aUo T.*cit A l!BOi*i' (AreA. f. k.(tn, CMr., IH09, XL, 
p. 184). and RASVian {Ifvtie. diet ttn metUr^ el tie ohtr. ftrat., I87l>, XUt, p. 873). 

Canalisation, so-cullwl, of thrombus is probably only a trnU-cuUr or 
net like organizutiun of it ; the canals traversing the thrombus, which ante 
fi-nni parti»l destniction of the thi-oinbus^ sometimes rti-estublish the cii*cu< 
lation tbi-ough tho obtiii-ated vein. EHpi-cuUly frer)ut>nt i« tins ovoul in 
tbe cases of nMX>very of phi^tjiiumm alba il<Avivi in lying-ia woiueu. 



i 

I 
i 



CArSES OF TiiBoxmosis, 



193 



Tbc BBanTM which cxUt iu tbromtiis ub p«nn(uiCQt pAmagra are alwa^ri fouud in 
tlie periphery (O. B.inTIl, Arc/t. ft. IJeiii:., ImTO, XL, p. 03). 

CAiiCARiior>8 rRANSFORjiATiny of a coiigulum is rare; it becomes gr»<]u- 
aIIv fiinallir, fiimop, *!irty whito or yellowish in color; latpr, pftloareoiis 
Halts Hnr ilepositcU in it. Tims also are fornipd the BO-calle<I vcin-stoiiea. 

Thu origin of Pis c-vscbh, and othiT new forinafions in thrombus U 
uot yot dftnotiHlmU'dj but from tlie fHcta of itit orgiitii/jiltoii now known is 
Mftreiily (Joiihtfiil. 

A complf-tc msHOKl^iflx of thrombuH, with re-estalilishraent of the cliiuuiel 
of the v^&tel, liax not a» yet been |jroveu, but is probable; » jiarliul reiiiorii* 
tioa uf it IS i^uiti; fn'i|iiont. 

TUp BEiuvioft or THE WAU. OF THE VKssEL at tJio locality of the 
thrombutt vi\nus. tt rarely happens that all maci*oscopica1 diangea of text- 
ure »rti wanting, uuli)»s tbe cuaguliim quickly atu^ume tlvu molecular st«to 
and the viitst^'a cliamiel Iwquiirkly rtwluitil : this otxurH usually iu venesec- 
tion. Iu the organization of thrombus the above-iie«criV»ed changes in the 
wall of tbe vessel takes filace. At other tiuietj texturnl cIiangcB an* found 
of a more chruidc uatniv : most often a Uiickeuing and greater vu»cidarity 
of the external eoat and surrounding eoiiiiective iiAsue, in the veins some- 
times aUti u like degeneration of the middli* and inner etjats, whereby (licy 
oienme a more arterial churiu;ter. In puriforui liipiofaction of thrombus, 
the intima becomes eloutlcil, ilead ami Initfle, and after removal of the 
coagtdiim it* torn away in 8hi*e(|H, or reuuduM liindy utturln-tl. Cuuceming 
other elmngi'R iu the endocardium and inner coat especially of the larger 
ftrteries, viHr infra. 

The t'AUSKS op TnnoMBOsia consist either in singnation of tbe blood, or in 
diADgca in the wall o^ the vesael ; or both conditions arc present. 

1. «TAOXAT(ON OF TUE BLOOD. 

a. CONTKALTIOX OF THE CUJkNN£L Or A rXBSEL: THROMROStS PItOM COM- 
rRlsiaiON. FreHsure UfKin ve-ssels causes first a retardation of the blood- 
rtirrrut in a part, and coagulation of the blood. The roagidatton does nut, 
however, remain confined to this part, but is also continued into the peri- 
pheric vessels. Thrombi have their origin thus: I.<y ligature of the arter- 
ites or Veins; by suppuration and tuuiors (tuberculoid uud CHrcinomatoua 
lympli-glandft), which pi-ess upon the ai-terioh and esjiecially the veins ; by 
elTuMons of bloo<l from contusions; by oicatiicial omtractions ; by dislooa- 
liou of bones. All thpso conditions aie so much more etfectivf", if the 
Hrteiial current is weakened. Pieasui-e fi-efpuutly iul.s upon the larger 
rmscla nut imnu;iliiitely, but rather upon thi- capillariits of a |nirt or of a 
whole organ, and atTect-s only the arteritw and veins indirectly, since 
tlie vi^-a l^rffo of the heart can no longer reach the latter. Coagtila- 
tion exieuds tlien from the aipillartes tu tliotte larger ^eins in whieh tho 
blond-iMirrcnt is nomiol, loss frequpiiily into the artenea. llere belong 
those coagtdntions which have their oi-igin in organs organically changed, 
in the bnindies of the pulnionarj' vessels in chronic pneumouiu, iu the 
ri'iml vt'ins in par«nehyraatotis nephritis, in the portal vein ami hepatic 
v«infl in ohronic hepatitis; in ]>art also venous thromboses (trauumtic) in 
votinds of the external surface. 

6. Section* and LAiEiUTioy of VEtusEts: tiiavmatio thiiomdosis. The 
latter hi the most important condition concemrd in spontaneous as well 
as in arttficiul blood-arreet. If the continuity of a veaael be int«rruptod, 
13 



CAtJSES OP TFIROHBOflffi. 



tbofc follows cHhor a continuous hlewding, or coagnlntion of the btood^ 
In tho lutter ciise the »rtei'ies rt'truct sotutwliat and Ijecome can- 
striek'il ; tliei*e arises with or witlioiit ligjitm-P, a tlircunlms reiwhing to ili8 
nearest ei)ll«U'rHl lirani'li, which throiiilni!* ffir ilii; umst jmrt ln-coiae 
orgHiiized. If tin artery he lij^ute't, e.ff,, in an ainputation-fttiiniii or (ool 
ficoount of peripheral hicniorrhRgo) in its continuity, the intitna bopoiu*** 
lawratwi by the strong tyin|» of rhu lijjHlure, hihI in drawn into finfi, Iongi*_ 
tndhml foKls which nrr? visihlo for months, while Oiv miihllc coat «nd 
mlvi'iititiA are constricted and thereby become plait(.'d. The folds of the inid- 
dlo coat, and especially those of tlie iutima, contiibute very mnt«rially to the j 
ndhcsiiiri of th(> thrtnnhus. The veins, *.(/., in an uiiiputution, bpeoni** diA^I 
cnnnootwl from the heiirr. thus* h<;ing do[H'ivod iia far as the nearest collatcr 
bratteh upwanl of the ri^-n tm-ffo, whicJi drives the blood forward- Thai 
latter eitlier settles Iwckwiird to the wunnded surface, because the veins! 
are eantly compresKi'd by the f(iin-oun<lin)j; Btructiiro; or it cotignlatcM, usl 
itlways happens, iit lenst Ut a ccrt^iin extent. Moreover, the backward flow 
is rej,'ulated by the position of the valvet*. In veins which are without 
v.iIvl'w, and whi^h from phy8ioIo;;ical or pathoIo>ricaI caiiHca are upeni 
(veiiuitH ph^xiiH of the hladdor, n'H^tiiiii, vciiifi nf the |in-*^iHnt iiUiriis. cntuiAlJ 
wniisea, cerncal veins, veins of bones), thrombosis nc'|uires a, much grealcrj 
extent than in veins which possess valves. In the latter, r.bo vaIvm exertj 
« very important influencR on iho exten«ion, ate., of thrombosis. 

After eviiry vrnehection thuro rftstilw a rnilxniiAOoouii ctfation of blood and ■ 
cntuniliiiu. whj[ih exCeuilit from tbe woimd in flii^ akm iutu UuiL of the xttin. Ttui 
oofi^illum is Buiuethncfl formed already fltirliig' the venetieetifiU (iu Amall woonds of 
tlie veiiM. in fthift^ng of tht; p itiition at the sklo). The pnrt of the coAgiiliim which 
pmbnideB into the vein beeoiiHM i;rt'Uiiill.v Ktn&llcr. denser, and paler, liecomes oqpin- 
ixvA, aad dose* the woun>l. HoiuoliiiH-x. hnwcTor. from, e.i/., bad dre«nuga, reat- 
IcMQesa. etc., new coatr"la arc dvpustuid ou Umt |iart of the cuairnlttm wUeh 
prutradea iuto the vein; thtis, uk at tir^t. ^viuf; riKu ti) w puriuiui'tnt coagulQia, 
which ander oertoia ^cnmHtjuic<>s in partial, or whnlly ot»«tnictii the vcMRel. 

In AXrnTATloNBof the eTtremitif^.f tbo bloml found in tho lotrcst fMUt of tbt 
Teiiut helow tho first vtUve abovo flows out. The rein itMjlf umalty oollapsbA. partlf 
becauAC Oa oooteubt have eHcajKid, partly becAiiae in Teiu.i with very muacular walU 
(veluH of the akioi, a truu c-onlractioa nf the lutter taket^ place : the chaiinel tbui a 
very xraiU! or aitaj^BLher dbtapjNJarB, the intiinu in fulilml IoTi[fitudJuall^', the wbilfl 
vrnll of the vein is thick. In like manner, the blood neari'ot tn the Hurfae*' of (Im 
wiiTin.1 njtiialiy RHcnpes. if the channel romnini nppn, iw in thp veinii of ImnM, ta 
indiita'woil hjpt^rcrophy of the external coat of veins in soft part4. Throiig^li inflan- 
motion afTcetinft the surface of the wound, in which the veins also take part, 
the chaimel of thf, VL-iu^ becnineM u.-irt-owcrl still farther; the resultio;; grann* 
lation't heal into n ciextrix anil then permanently cIikui the wnimil nf tlio veins. 
SometimoK a small thrombui le formed, if between the wimnd and ueoreM 
valvet above xhtn open into the voins one or moru sm-ilkr branehev. from 
which a little blood flr>n-s iuto their lotrest exLremit/. At othec times ooa^U 
are Cormeil of grerib tbickne^ and length. These depend upon thu rclatioa ot 
tho oollat'jnil bmnchc;* which opim into tho vela above the lowfuat valves. If tl» 
larger collateral branch open cloMi a>M>ve the valve, the blm>0 of the cut vein 
nsnally remain*! in th'3 circniation. But if inich a branch in wanting, or in too smaU. 
or iOt other extremity is also cnt aoro-n. then the nix-a-friyt tUv;* not uffit-'t the hjiiod 
above the lowest valve, and the blood coagulate* usually wiih a rapiility proportino- 
ate with it4 nearness to the wouuilcd surface. Be'idex thiii naturftl cjinliUoii. then 
ara yet otht>n which promatf! 0'>:tgnlatimi : unfavorable i^OMtlou of the rnrrab^r. 
miftapplied drniMingH, wuikneHi iif the heart'n impulsu. hluo:! (tti>]ii^ly tltapdMsl to 
coa^latiou; lipttnre of th« cut veju (whereby more or le'Ui of the iJuod in the rcis 
to the tinst valve above escjitCH at the moment of ninpntatioo. hut also usually oo* 
blootl pours into the extremity nf the vein through small olLit^irat brauchea oiJenicf 
inty it|. If nuw a cua};ulum in formed of raurc uimsiilendilu vi'lume. it** ecutnil enol 
n^ually reaches to the point where n lairer coUatend branch npuntt iuto the vsia. 
To this free euj new ooagnla are added from the blood of the ooUateral bcanidi, 



\ 




cArSES or thrombopis. 



195 



"P^ettihy (.Ke tatter tfm, ontl fium this again the next neaiest yma. mtky become 
obftCniirtttd. 

After rviiTCRrTlos tbe iitcnii present* o Lir},»o wiiuinlej aurfaixi fCitrvKll.lllKtt 
in npi-OMJiion t<i W. UrNTEii. uud others, accmliosf to Hrliom n pnrt nf the dfcidoa 
i*m«iQ^ brhindf. Xot infrvqmMilly. aftfr ortificiiil liirtlii'. i-Hp*^cinll;r after nrtiHciiil 
tlplivmr}' of tbe |>l.v-«iit», thf tlii'ik uUrim- iiuH-nttM Tn''ml<miie in its Kii|>ertit'i;il at> 
well ta it« deep Jaypr. is t<ini off, Invirjr I'ur** thy mii^jculnr Ittvcr. Hosidet-. wounds 
aw frc4)U«-Dt in the vaginal mnroim itit>mV>mn(>. in till oxtemal o» nrnJ \viibiii t4n.' 
cerviiL lo all thme wooiiJc-d |iart* vo^sr-U wf viirious w»Iil)r<i ait* jiUti lHCi'rat«d. A* 
MHRt iift«r parturition an Mtroiig con tract iLiue of iho utemit rip|ivivr, tbe ut«>niii: vm- 
kI> also lieoomu iiuuhnnii^iilly f^'>n]plVKuM, atid the ItlfMul in tbrrm in fur tbe iniMt 
port, driven (Wt, BuL a part of the blood nhva.VB remain!' behind in the ve^wdii, 
bci^HM' the ciintraotiuos are never no »tn:m.:f thiit the channel of ih'j vensols is L-om- 
pirtrly olowd. and, too. Itecauae tbe oh-rine veiii« are without vRlven and tbe blond 
ttawuti: iift in repluced by now bloml. Tiually, fine conffnla probiibiy alwuvc (frovr 
ftxitn the oua^Uum found In the nlcrinu imvity into th<.> nteritiu vvMieU which open 
into itw 

c. Dilatation of the vkhrkja asp heart: i>iL.vTATioK-TiinoMUi>8is, 
With fN|iii(1 iptanfitii-H r>f lifjnifl tbn nirreut ih mIowit directly as tbt^ siw.' of 
ibe cliannel ; in pouched lUlHiiitions of tin* vessel thcrn are, besidea, border- 
ing Ktratn in n Ktatc of i-cwt. Since the central part of a atrt-ain i« iior- 
inully the swtftiT, nnd tbe |<eriplii'rftl tb« slowfr, congiiln ore tDostljr from 
the Imginnitig attarbtHl to the Wtill. They n'main (•ither its ftiich nnd softf^n, 
or become orgnuixod, etc. ; or, the coa^'uUnn Uorderiug tbe vessel-walla 
gradually forms a complete oljstriiction to tbe current. Congtila more 
mrply fnim tlie lieginning (dwtrud tin* ve»a**l ciiinplflely : Ibus in genenilly 
iiiUiti'd veins, f.ff., ihoHi- <»f ilii> bro^d lijinnwiits of tbe uterus, Aualogoua 
to this thromVKwih nf tbe veins is ibe t'nrtinttion of enngidii in nnmirisnial 
arteries, tbe rorniHliuii of glol'iiliir vfg«ft»tiniin in the beart, where* i(-s walls 
neari'Ml to the endncanlinm or tbronj;lioni the whole tixtciit of their thick- 
neftn ba\-e undergone fatty degeneration nr induration, 

M«;re W.M.nRVER ti1n<a«C3> thn«e ra^ex, in which, after wonnfls or operatinna, gan- 
grene of tbe part qniokly fnllow inflammiitdry enngiifition, and tbe vewwlii, eKpecially 
tbe ToiiM, aft^r the Iowp nf their contractility and chuttoity are speedily transformed 
into a wft, pliahlv, piilpy tisi>uc. 

d, Mabasmic, ATBOpifir TniioMBosis pxists, when dnring a redxiction of t)ie 
fyi-ce of tbe be-^rt, of t!io walU nf tin; voftsels, of the respiiiitory innselca and 
of the mnscles cxtrrnal to and in tbo vicinity of the veins, roagida ai'w 
fonnwJ in the larper veirin. CHiicrially in tiie cnn*al nnd ilioc, in the tnuKen- 
lar branches (those of the glutei and of tbe lower extremities), in the 
v^iu>nR plexuR of tbi' pidvia. in the cr-anial siimsea, etc. The ens*' with 
"wliicli this takefl pUico in jtroportionale to the quietude of the |ierKoii 
affectcil. Ilie (iiTtt lieginningn of coagulation occur iu tbe angle behind 
the valves. TbtK thi-omt»osLx ih often foiuul in thrise who »re in a state of 
low ntit.ritioo after severe o]>eratiotis, for wiiom ii long pnriod of ijniot 
lying down, is iiei?r«8Hry ; it is n fivfpient wfjuela of diswise, of severe 
f*»hrilp diHeaseH, esperially of typlioid fever; it is a common eouiplicnlion 

:jii chronic tuberculosis, of chronic atfrctions of tiie joitila nnd bones, of 
rvrn; afiecttoiiit uf the ninsclefl, of trichinoHiH. 



2. rH*XOES AFPEf-TtJCO THK WALLS tiP THE VESSELS. 

fi. KoiUiiisKSfi OK THK istf.uxal COAT OP THn VKssELs, dependent nprJll 
ihfdr dcgeuemtion (fatty meti»morpho»!is, etc.), r)r upon infiltration of pus 
into tbenit or ncw-fonuAtionH (grannlation-oells, as in orgBniuifion of 



IW 



Cirsw or TiiKoMBf^sts. 



ihroiiibiis —vut« p. 192), whicli cuiitlitioiut biusti al lirst a tlirom^ 
lining tlif> vestwU, tbt^ri nut iitrLvriupiitly ono of n general cliaract4-r. 
conditions are fuiinil in Lutluuituutions of the rout uC the mins, ea[>ecdull<r 
in abscesses of thorn, or of tliM AtnictutoK surroitntlinf; (hum, iu new- 
fonuatious, ospvcioll.v cancer, which porforata the vyiiu,, in chiximc endart- 
pi'iti!>, and in cndncarditis. 

In experimcitta with rosi«ci to the rcltitiotm cxit<tio)i; Victwecn ihe iDlima ami the 
Uoutl lu olcHH-'iI VUUOI1.S |>uiiutiu». UrnANTf: i'JtXr. J'tAHt., 1871, p. 'iii\) fimtnl that 
thu I'lotiil rutiifttiK'i] li'ttii'l n> lon^ tut no iiUKuunatoiT' ohangvw hn<l utkt^ti lAaca. 
throiijfh the mpchfinical iiiitati'in nf thf n<!tHlIi'ii iised. nnci thiit canjipilation of the 
blood went bnnd in hand with change of the onrlnthclmm. D. ihemfoT^ aMmmed, 
that the tluidity ot the lilood sliut ap in a vewel u depeodcot upon the normal Fiiuc- 
ttoiui of tbu ve»iol'ii walls. 

Pni-uniTifl ui iCi4 varitniH forms h a chief (imine nf thrombcwis in nevpre woamU of 
eTHfj- kind, frequently witJi pnnilRUt or iohi»ruuH lii]iu*f:urLian of th« thmmbiiN auil 
oon-srcntlvo jivfimia. Emxkauditis chWlly nffoots tb*? vnJvcs. ctipoclnllv thr nnrica- 
lo-vcntrJculat rnlveft. UncvonncKAeftariBCon tb*! imrfaoes; at flnt loofionmf; or hi'pti- 
trophj' of lh« ciidotbelium. then thickejuiif;: and }^rjuiuIation» ot the ffnrfacui; fuihll^, 
ohalkj' and fatiy inntntnitrphoNtit uf ihu wluile valve. All tht^wi ium|Daliti«» Ixaccraia; 
the causes of nnmcrono dupositA from the blood, which in f<>nn of warte. oondylo- 
mata. etc.. uttnch them.'wrlvc* t^ the valvee and Urnily ailhci^ to them (v«((tt«tion*. 
cxcici»reuce«. etc.). Chronic ENDAKTlilllTTS. which ooours iu art«rie» of ereiy 
oalihre, cauaes hy fatty dv^envmtiou nf the t-ndothvliuiu and of the normal or hyper 
txnphlcd isncrmoKt layer, ut hy calcifiuatloi] or ois»ilicatiun. ur Hoftvoinf^ uf the latut, 
somiitimoR only sUpur^cuU untivuimeMi, HumtrtuntiH Jcc^Kr lofuicn of Mubstance. whidi 
Ijive oofM^'ion to ooo^Iutiortit, ko innnh the mnri!, if thn middle coat MmulCaneaiHly 
di't^uerate. with Iom of ita elaatiuity and oonCractUity, aiid the valid ia untfnrrDlT 
or irro£ruiarly dilated. 

6. FnitRinN noDiFS in n Kinillni' inniiner givo rise to coftgulatioii iti the 
x'esai'lfc. For cxnni|>le, neeill«s, gmins of Kbot, splinters of Im>iip; or 
thread, which, oftoii for the aake of ex|Kriment, is ch-owni thiijii|;h thfl 
veswl. Coagulatiuu ouciirn lintt iu tlie tnititi>OiAt« m-ighboihooil of tit-* 
foi^ign body. BUKH)-coa}j:it1u tliemselves^ tht-oiubl as well hs emboli^ art lu 
tite Kuine niiiuut'r ua llKeigii )>odiL'5. 

Iu this alao la iucluilud ii.eUDKftUAorc ttirouibosiK ; iu blecdin<rs cnuguU- 
tiou ol' th<? extcaviuuitvil blood naitaUv OontUiuua tlimiigli the injury into 
the veaseh ( ftc/^r p. 194.) 

e. Cnr.ntr.AL 8fU.STAS<-EB cau.sp coAgnlation of tho Wood, whi'ii thn 
either effect changes in tlie bluod nud wall of tho vessel at thi^ aauit; lliD' 
(cautitlc^j), or when they tlirx)U;j;li the latter, ^>'it1iout nuittiriully changing it, 
coiutiibite itH oiintoiits. In (be latter, according lo others (nV/c I'v.eUUl, 
the ictior of niortification, and )Nt<l ptiH p<rrl)ap.s iiUo net in u mi^chaliictl 
manner, giving rise then for the nio^t part to an ichorous ttofteniug of tlic 
thronibuH. 

Not infre(]nouUy throml)OHiH has its origin in UANV cal'SES at the ftamo 
time, in arrest of the Wood, and changes of the walls of the hejirt and ves- 
sels, often without the tirnt or most ini]>ortaut caufio being i-ecognizeil m ihf 
living, or in the body after death. 

CuAiU'LA tiirruKiNO IN MiitMAL vtssEijs coutiuiie their growth in • 
vc8M*l, thmr origin licing cithur in a brunch, or in the vahsoI ir>8<;tf. In die 
first ca»e, the point of the; coogidurn acttt ils a foiTiim body> and i.-<:))igulHtioii 
may thtiH extend, e.t/., fi'om the veins uf the lower part of tho thigh into tlie 
vena civva, «nd even to the heart. The bbwd thereby congnlutes mo*i(ly 
ulwj iu thoHC veins which cntl near that first occupied liy the thrombus, 4^ 
Trell as Rrinietifin*s in veins of the same nnine in the uthcr half of tJti) 
body, if the cougiilatiou once extends to the vena taiva, and into All it* 



^ -—-- 




As OF TIin031IK>Kl!*, 



lf.7 



Michep. Tlif Iirancliea uT ft voin becuino much more oiutHy ob«triicte<l 
#r its thniinlMKsis. 

Or, the congiitit occurring in normnl vessels ari? si-condnry. Here belong 
? coiifjiilit it) vt'iiiH the ca[)illunt.'» of which U^ in orgunn intiltratod with 
B or cniicvt'oiiif niiiiLrr ; tliH coHgnla in iirtcnes, the periphery of whicli is 
!it.riicte«J by gnngceue or intense Biippiiration. 

FiuhIIv, obi<triictiou(( which ujipeur in ni'tories after embolittm are con- 
ned tliii>ugh the CiipillarieH into thu vuiuKj luitl veuuuu tUruinbi may 
;;nme rbe oaiLst of new enilioli. 

Tbroubosis op tu£ i'APiLLARiRS hna an iini>ortancc only with i-ORpoct to 
iaflumcff upon thn hiialing of wounils, lunl cliiefly through its continu- 
ct> into the »rt<?rieH, and es^Mtriollv into the vbiiir. 

TiiHOiiBORrs or THE LVMCiiATti^s h lejw fn^^jlt^^t thnn that of the veins, 
d hn5 bcon obRorved only in iaolatud tocaUticR. 

Phn o«»HgnlnhiIity of normnl lymph is vpry xmnll, in spite of Us contnineil fibrin, 
1 cberefnre dhows little di*iK»!iition to thrombonis. ITnder patbolofrical conditions, 
ivcvor. n<inti:d l.vni|th Is nuppliuitdrl by annthiT lii|nii1. which i* cithar a tmcA- 
mal riliririo^'notis ^u)wt4UlCV, or in part n dpeulid ftbriDO-pliuttio Diutvrial itxciuu^ 

JttLicn. lA ScuMinx.) 
uphatic tliroui bonis in found Id many tevere paerp«ral fevers. The uteruio 

batica, often over a lar^fc extent and far beyond thu utc-riLt. ar« uiiifomilr 
atvl or knotted, and filled with Holid or tluid, yt-ilrm'iHh, oft«*a pnriform innf<»it.-4t. 
rg<e poacb«ti ikre ottODott found in ihc U'/. Uitum. espticinlly in the oUt rrJtprrtiUmM 
ur thf iu-ocrtioo of iha tubo«, aUo dci-ply near the Uteral bortlcTK oF the utomii, 
m to tbo attachments of thff broad Uifuiuents, and at the other extroraity near the 
M ^u-f.n'Uioi intrtni, riiachinir as far as LbB Inrubar gbiwls ; tlicy nrc foiiiij aImi 
tbt* «:dl (if the atenoi. etipwrially <>f tiie t-wrvis; nlso in tbo ovaries, wbicli from 
ur hilitK art 8om<rtiTn<M olotftly intcrworen with nncb ubetructe^l and dilated lym* 
atioi iViucHiiw, Arch.. XXIII.. p. 41.>t. 

Uoiunilt aUo the ohwrvattoiifl of UiKi^tADKZRj (L C-) and of the aathor \Aroh, (f. 
B., 1870, XI., p. 51). i Vide Pv.kuia.) 

CuySBQlBNCKS AXn SVJIPTOMa OF TIIBOMBOSTS. 

Thrtw iu gonoriil coimixt in iiHrn»wing or complete closing of the ob- 
mctetl cajwL Tht.*y am dimiiigiiislicd from the nymptouis of ombolisiu by 
eir coiupaiatively slow appeanince. They change not only with the size 
vd mtitAnjnqdiohf-B of the r.hrooibnK, with ita rcdationa In the wull of the 
Mel, with tim Liml of channel alfect^d (heart, artery, vein, tynipltatic), 
f|Uiey al(*o hhow otlier and niiLnifohl diffeieuct's, which allow no I'aither 
nerol consideration. 

The coiiKCfjncncctt and Kyniptoros of tkrou basis op ras veins depend 
lou the sixe of the veins, npoii their dcptli (Hiihciitaneans or deep veins, 
c), uiHiu the thJckn(>MK umi longtii (d' Iho thioiuhuR, the rapidity of it^ 
iiimtiou, its metatnoiphoSL-a, iijion thi^ thiratlcio of the thrombosis, U|>on 
e pciti&ibiUly of the formation of a coHateml circuhition, etc. 
TliromlMmiK of the veins runt* it tH>ui-s« wiTiioiT 6VMET"">Mg, if tijc obstrue- 
>n tK incomplete, or if it utrcct.s a cuuitniinicaling brunch and there ai-e 
.Ificit^t (xillAt<<i-al l)i-anche.s. Thus in the deep veins of the oxtiitmitieH, 
the uterine plexus, veeical plexiin, etc., where there exist nunieroMM 
rtniuunicHting benches. The uriialler vt*iu4 usually remain froe, and thus 
« nt^tertioiat vehsnls ap|>eariiig dLsWndeil, supplying the ooUareral circula- 



If thntmboaut aSeot the aniill veiaii, and the onllateral oommnnication be impor- 

ct. without uoni|iletfl Btaiihi affecting a lartre territoiy. then the reaction ta confined 

the wait of the veawU immedtaitil}' affected, n*hoM! Tessels of supply are ub- 



BYMITOIIS OF TIlKOatBOSIS. 



Btntcled ; there arine a sli|;ht iiiRtunmilurv itwi;Uin){ with modornto reilncM;. btifM 
pain, ant) waU^ry inrtliration of ceilatnr jiliuie^; Boiii«tijn«s al«o a ntron);er trhiAttOD 
wth liiiiitetl FiipjHiration. This is moat ofwu weu in bieniorrhoidal tninorK — ho*mor- 
rhoidul «woat noii oxcix-tiouu. itcbiu;? ut the niiua, abMVsaifCfi in tbd surruun-iuijir ti«- 
eaeH, plileg'tiiouii iu varlt'ca lO. WErtEK). 

Aocordiiij,' to Fhikhi.vnueu {P/iyi.-iittrit. Vntfrn. ith. d. VtcritM, IKTOl the plft- 
oei)l:U portion of tli<> utt^riiii! hinuMiB U in i^TRiit {mrt nlt^iruiitiMl at the eighth inoatb 
o[ pr«ifimiiny, nml, from thu accarualntion wirhiu thum of Inr^^A inultmnclfar dcUk, 
there reniiltt roaj^lfttian of Che blood and tir^iiujzailcpu of the ooogultim. Tbe pro- 
o»M of KhriDkin^r of the 1aU*:'r goes ou no KJowIy. that the tbroiabi rotAin their 
relativu size for uliuuiit a hulf-jrcar iiftiir cliild-Urtli, and on the out mrfuce of Utfl 
uterus appear ivt geiutinous, cnuui]utuut bodiuA. 

But if hii-jje venous tnniks, as the crural or iliac, art' ol*triicted, 
tlmnnlii Itxtsl, Hri<I tlie colliili'ml rii'ctiliLliuii iiiMtilHciciit., ttirit them ii|)|k-ar 
svui]>toms of ULOUIUSTASI8, cliietlv' (EiiEMA. Tiils a>deiim is ustiitllv uni- 
lateral, ami generally in those nick witli ch'o[r«y, i¥<leiuu of the extremitim 
with vciu>UK ThroiiiliimiK in fur tbe ituiMt |iHrl nioru niurkeil. (Kilfiniui an? 
UBuu.)ty |miiiU'Kh; painful in ilie higlu'Ht Je^^ivce when thu oLstrtietvO and 
Bonn;w!iut ililiitetl vnins lii; nrar nervt-x, as, rf.j/., llu; eninil close to Pouparl's 
ligament : lit-nci; ilic name pltlrijmu^in alha i/ofrna for the avleiua, for tbe 
nioHt ]}urt |niinfttl, resujrini; from ohittrnctiun uf vciim in l^viuj^-in wonifn 
861*0118 effuKiuns oi.xur in tin* region uf the ciinillurics anJ wuons rtnJich'A: 
hence tliGV first ap|>t>ur in distant jiarts, r.y., iti the oiiklos aiid lowur part* 
of tho thi>>h in obatriiction of the crumi veiu. tEdeuia is wnniiog 
ur diKaitinrnirs, il' the thruinbuR merely line» tlie >688e), if there ext.^ta » 
fnifficient cullHteral cireuhition, t^ whII uh in aecondary canalisation of 
thrombi formint; complete oWtrtictionH. HifiuoiTlnigcs nccur in veuoui 
obstnictidnx onlr^ when almost nil the lalerul duinnels are ulwtructetl, anit 
wlicn lliroMiboKis follows vi-ry liuickly. Gaugi«&e appears otily wh«'U 
fn>ni other iransea, r.ff., ill puur|H»ral ft-ver, crysilK^hlh in H(b)i-d. It ia not a 
diix-ct consequence of venous obstruction. Klevated leinperalur*. *'' reJema 
caiidu7n^^^ is observed onlv in robust individuals, as in ni<»st puer]>end 
wunieii, not in the marusmic. Diiatatinn of adlateral veins almost inni»r 
hftpix^ns: in thrombosis of tie- crural the eulhit<>ral circulation bt probahlr 
jirovided for by the wxcral and luinlmr veins. Very nuvly is the olwtnicte"! 
vein, even the crural, di-sunttly kminn by the touch. Only obstnicied 
cutaneous veins, *•.(/. the saplu-na, can usually l»e disthicily feh. If thiwn- 
bosiB exists for a long lime, there rHsults a thickeninj' <>f tie* skin Axid con- 
nective tiasxio, even of the. periosteuni iiud bunes ( elephant Lasis of uxtcnttL j 
paiis). 

Coi»uU BnAiT^tR, Di* OimrMAenkdcfne da Meiuichtin, 1871. 

The Kyniptoms of tbrorabosia of the veins of internal organa, even whei* 
very extendL^], nud the veins i>e1uiit; to organs eaheutiul to life {*.ff., cntnial 
fiinuaes, venal veinM, vena poitjf) an- raivdy so clearly ih*tineii, that it 
becomes pof>silite to fniuie a safe diagnosis. Bi^idea the ali\-ady known 
consciuences of jtassive liypenemia (uHlema, ilropsy of cavities, etc.), therv 
are causes ejspecially to bi? takt;n into ctuiHitlemtion {caries, ni:ir:ifcuiii8« etc., 
ill throml^rsis nf the cranial siriumiH; plu^rpenll inHanimation of tlie nlfitiii. 
in thrombosis of the uterine veins; cancer of the liver, severe local itSnc- 
tions of the intestines, inrtnmoJ htemorrhoidal tumor*. iuHannnatiou of ili^ 
umbilical veins of the new-bora, etc., in thronilK»vis of the v«-iia [Mirtit; 
older iiilbLinmaliuns with the formation uf cicatrices in LhromU^iK of Uie 
renn.1 veins, vena porta), etc). Further, dilatAtioii of collateral cimnnuls, 
e.y., in tbromboaia of the ciituial ainnses, that of emergeut vtiin% of kl 



( 




SYMFfOMS OF TUBOUBOSIS. 



399 



froutal, oiihthalmic vebi, etc., in tlut of the veoaportP^, that of snbcu- 
tianeouH abdomiiml vetiui, is iiujvortaut. Finally, the ajipeamiice of tlie 
|>)tHn(>iii(^ii» uf eiiilH>liHiii draws utLentiou to its source, IhromboNi-^, 

Cf>n«ult. OD tbrombOBls of tbe niDuses, the mor« recent works of IlBUnNKit (Ar^fh. 
d HeHJc., 1808. IX., p. 417), and Wrkueui {Pet€n(0. MetL Ztschr., ISOI), 8. ot ». U.). 

All the symiitODis und cousc(|ueu(X->H of tlii-ombosifi ui!J.U'i<i£Aii tiftur wi>(>ka 
oi' tuonih!S if ^^^ tliruniliUH is n'ubr;orlK.-d or in suUicicutly cauaiizeil, or if 
th*Ti* in un abundiiiil. formation of uullut4!i-Ht uIihiiiii'Is. 

The inoMt iiii|>ortuut couBoquencu of tuuomihjhis op tiik arteries is 
AN.oriA of Uie jmrt (vulti p. Itjo). lint tliis ustiully i>SL'a|u>ii obs^-ivittian in 
ccwgulii of local origiu, bt-citiitie thun ciiagidu ari^ titiuiilly of gnidiiul formu- 
tioi). <.*aiigrtti)e of thf ^Hii-t Hp[>earK i.-itor, n'lifii tlte throiitbo^is i» nf ijiiifk 
origin, niihoiil itK H]>|H.'Hraucc boijig uucuiii^MuiiuU by ihu eMtablishinuiit uf a 
siitiBcient collateral cii'culatiuu. 

An«nal t^UmiiilKMUii uIko in iiiauy vatma in hiuoxiaxu tiimntrh Ibe iiilroilti'Ctiou uf a 
coIlnt«ral circulation. TiKitEMAMt. in the couree of a j'ear, lig'stetl one InigQ art«ry 
after au'fther. withont causiui; death. O. WKlimt hod a dog. in which be hod. 
within two moulhii, li);at«d both cacutids and bi>th f&moroU, luid whiuh was uutirdy 
weU. 

Th*" ftp*»ciaJ «\^nptn^ns of artei-ial thronilKwifi ifmarkably rpfteinhle thf.i«e 
of iiigb gratli-d uf chronic arteitliA sod of growiui; aniMirtKniA, and are din- 
liogiiifihed from those of orturinl enibolisin by ihe Hlownosx of their a[i- 
pcflLrutico. 

Thbomhosis of tlie ditiVireut tavities ok the hkakt, es|)ecially uf thuno 
of th<? right aide, is sometimes aUogeth<;r wantinj; in symptoniH, as in most 
so-cidlpd globular vegetatioug, bnt Rometii]iF:>4 fiirnishes uuscultatory Higiia 
(thi-ombosifi of th** auricles, etc.). The antecedent condition of the he^rt 
especdaUy (iliUtat.ion fruni fittty ]iietanior]diosi3 or old myocardilis, tjudo- 
cardiiiH), peculiar murumrH, au well ok the ap[>e«ranco of embolic: ttyiuptoniH} 
are to be cuuHidei'ed in the diagnosis, 

TiiifOMRi>»ii( OF TIIK i.i Mi'iiATicB 13 Bttcudotl bv DO marked symptoms 
{i-rife IJROPSY). 

Thrumlwjsij* nf the vi>inN ;w w(dl us of thn lympliatics «in ex«'rl u BENE- 
rK'iAi. iNFLiEXCE ou the orgiiuism, when, «.//., thoy affect vossels whoso i-oots 
Ug in u collection of pus or ichor, since then tho tliroiuboHis by preventing 
retwrption, iniiirinous, aa it wert^, llm injurioutt HubttLaucctt, and ku the 
spread of iDfectiou to distant part^i, eHpecially the blood, is prevented. 



B. EMBQI,IS>f. 

Thrombi, non-organized, gradually hecomn noftcr and more i-ott^'n. In 
tbrombi ]ini]ig the walls of the vpaseU ami purtiully obstnicdtig them, the 
blood-stream may tear oft" and carry away pieces of them, or remove jiud 
tKanK[Kin them in tfiU). TUm samn can happen to thrombi which wholly 
obstruct a vessel and are progressive in j;rowth, if they project U-yond 
the month of the vessel in which they were formed: the blood-stream 
which comes in contact with tlmm, with the puint^i of the puagnla, tears 
them, or piteea of Iheiu away, ami carri<fH theui farther on. In both ca«e-», 
the piiKren torn away are driven into the next narrower parts of tlie vessels. 
botucliiues hirjjc cylindrical pieces are removed [there are embuli of some 




200 



EMBOLIf^ : NATt'SK OP GSmOU. 



uioliew in Ifnjjtli nnA as thick .ir the fin^jer), sometimes the emboli »ra 
smalltn-, even visible only witb llie tuicroscoiw}. 

Tliat the ctx^nla met with in other pni-ts of thu body "ro embolic and 
not origimil, is ]irrtv«*n by miiny ohsfrvalions in tlie demi l»ody and liy ej:- 
pi^riiuent. One can often, by the tbrui, color, and Htratiticiition of the ^ 
impacted piece, be couvincRd, that it was torn from the cuagulunj o^^ 
another b^caltty. Niurn'roiis experiment demonstrate that the bUuMJ^ — 
slruani in able to carry Huch coit^iiU away with it, and even heavier bodies ^ 
Oil CKOutciioiic, piuceK of nniHt-h% tpiicksilvrr. ■ 

The pLArK UK sirfii siirAHiTioNs from thrombi is moat fi't'tjiientiv th<«^ 
TBNOtts (^IIAN'XEL, es|H'ciiilIy tUf cniral vein, in which pings aif? continum^ 
out of its iniiwidar hi-Hiiclnw; iH-siihrs, (hcrt! an; the liypuga*trjc, iliaiv:^ 
renal. jtt<(u1ur veiii!i. the cnmial sinusi?^, the right side of the heart, nirel,-Y 
other veins. In the autckul i'Ckhk.nt the fnrmali<m and separutien «/ 
cuagiilii take jilace e4[K;i'ially in the aoria und itH main branches rarelv in 
the I'uhnonary veins ; in the left eide of the heai-t on the mitral valve, less 
frofpiently on (he aortio valves. 

The coKSTiTLTios or natuke or euuoi.i: they oonBist of— 

1. Ill.ooD't'OA<',L'tA. iiio(4t fre^piently by far, which ua adtuclithonous ur 
continued thrombi have so ftti- chaiij£e<l their eonaiateiicy ilmt it ia pos«ilfk> 
for thi! blood -current to tnar pieeen from them, and carry theui away into 
the veBsels. They souietiniuti as a. whole pUy tlie part of etuljoU : ^s„ hs 
veiu-Dtones. (The general cousidurHtiou of tlie procuss uf f5mboliini 
ia ttaxeit ufion the fitriiinr ori^n,) 

2. 8nliaUkiice9, which orij^iually stood in organic relation with the wtUi 
of bloi^lvesselfi. Wli^n this cunuection ceaaes to exitil, tlie Kubataooei 
are ctu'ri<'d fartJier on by the hlnc»d-str»?ani, au<l act like optliiuiry emboli- 
Kxaniplea uf these air funjid in fr-agmcnts from the chalky, bony or at)wtn>- 
uiutonN VALVKs OP Titlf UEAitT, And from the degeiicrnted by|iertiH)p]iic iitoftr 
coat of the arteries. 

3. Subatancea, which from thf Winning are formed on the inner auHacc 
of the heart and vessela : e.(/., iNri.\MMATORY ruouui-TS of the t'ARDUc 
VALVcs {** fiffocftnlitia u^ceroinc'*), cai'cinoniu of the endocardium, vfiui, 
great lyiiipbaticM. 

4. SubstuncH.t, which have their origin outttide of the circuliiton* aystvifli 
but by their fjrowtli |*erfoi-nte the walls of the veasela, liuully reach the 
veiHtels' iiit4.'rior ami there become fi-e»; : CAttt'isoMA and abscesbbs, mow 
rarely enchuudi-oina and aarcoimi of tub iikart and veins. 

Here B^rrcncft'a eaaa partly tKlonipi : in metastatic renal abaoeaaes ^loKticGhm 
were fouml which had been transported fni.n pidiaenaiy abtoeaaes. < Viilr Stonniluj 
New-fornjatioHH.) 



n. rARASiTU- PLANTS AVD ASlsiALS, whjcli, by their increase (bacteria, 
echinoc^ccuH, etc) or wauderiii;^, find their way into fcho vesaela (etubrvos 
of tape-wortiiK, tlint.jinnm /i/r./nnt'ihiiini, trirhiti't apirttlis). 

6. Corpuscular substances, which tind tlieir way into the vaacnlar | 
system : li^liu tat. aih in thi: bloou, and riuMBNT-MOLECttics in melaiiv- 1 
mia. Fat tn libtiirliHd in rntrLiire nf normal iNutes, lairHmri'd af)i]KLH>f ti!»nif(-j 
etc., and is not infivipienlly found in the vi'in<4. wlieinM it piix^t^H into th« i 
genentl nijtaa of blood, and especially into the lung^. Air euluifi the cirvu* 
lation throngh woiiiuLs of the veins, sometimes also in a manner unknown, i 
Figment'iuolecnleii in metanffiniia are probably nlwaya taken np by tfas 
Tcina from the spleen. 



Euitoi.i : CArsGS a#''%usOLiflu. 



301 



. Biiinher of substances, wliicli do not enter the oirculiition except in 
SOLUTION, and are deposited in detiiiite localitieji : mktastases. Hero buloug : 

a. Ndriiiu) Kuliataiices of the oi^»niani, wbii^h on account of !^seu«(l 
BKcrvtiou tlii-<ju<,'li tlio vciiiB aiul lytii|>Uatics, acciunulnt-c in the (jt^nei-al cir- 
culation And Are deposited iu vanoua parts of the body : esiiocially the 
coloring in»tter of the hilo. 

b. Norniai Hulmtanccu of the boily, whidi in van'ouH ditMraives are not 
bonnaDy iransfnrnujd or cxt!i'ete<I, or wliioh are fornwd in iinrt'ahcd r|Mau- 
tity : thns, uric acid and iu salts which ai'C deposited withiit and around 
fee joints in gout. 

^^ Siibstujices, which accinuulate in the blood in too great quantity and. 
l&b nut nunnully tranMfovnie<l or excrut<Kl: thua linie-saltH wliich, in oHteu- 
tualucia, cxtt-nKive carh^s of the )>oiieti. iutltuiiuiution of tlic bones, are 
deposited in the kidneys, hingN, slouiHch, etc. ("chalky uietastflses"). 

(/. Slany mi'dicaniontti, h-j Nilver-Hiilt», which are iteposited in tlie tskin 
Ubd rvnal tiasueu, and salts of lead, in the gums. 

CAUHK9 np KMIIOLISM. 

The PMEiiifieosiNo causes are given aliove. 

The EXCiTix*; caukksi ur*^ during the existence of ordinary thrombi, in 
particular, sudden ninveiufnts, quick rising out of bed, nudden changes of 
poHitiou, titiaining at titool, cou<;hing, friction or pcetiHum on tlirouilHiHed 
vesBols. For the reniaiiiing emboli, not cunaiating of blood, for the most 
{Mirt uo exciting causes are nccesiuiry. 

Tmk LoiMLiTiEs INTO WHICH KMBcLi AHK fORCKU are: with resjject to the 
emlioU formed in venoun blood, iia in the veins of tlie gi*eat cireuhition and 
in the rigiit side of the heart ; in the puhurmHry arteries and tlieir branches 
(e^nlKili very rarely remain fixed in the heart itself) ; — with resiieet to the 
pluga liavjni; their origin in tlio arteriHl Ijlood, as in the pnlmunaiy veiJUJ, 
iu the h'ft isiile of the heart, iu the arteries : the arteries of tbe body ; — with 
respect to the coagula formed iu roots of Tona porta; : the he[Kitic branches 
of the portal vein. 

The l)iRt£(.-TiuN' OF EUituLi of large size is a toh>rably constant one. They 
usually tend towar<l thf posterior and lower jiarts of an organ, in obe<Uenee 
tt> the law of gravitation. They tuke die diivction of the lunin ciirrent, and 
puH* into tlio hiteral branches only wlicu (.he foi-cp of the current in the 
inain VKMnel is very small, or the vessel is already obstructed by emboli, etc. 
From only exceptional and unknown causes tlo they enter branches (>erpen- 
dicular to the main veasel, f.ff. Into the ctaliac axia, tlie ooi\>nary arteries of 
tbe hearts the bronchial arteries. 

Emboli from the left side of tlie heart usually pns.s into the thoracic aorta, 
and from here most often into the aixloininal aorta ilu<1 renal arteries, as 
well aa uito tlie iliaca and tlieir brunolias; somewhat leas often into the 
carotids, rarely into the subelavians. Of the carol id, rttiuil, ami iliac ar- 
teries, those of the LKI"r sihe almost exclusively are alfected by embolism, 
cincs in th^m the chief cunx'ut has a more direct course. 

Kmboli from the veins pa-ss iiiowt often into the lower lobes of the lungs, 
apt when the latter ai-o infiltrated or coinpi-esjiwi, or wln-n their larger 
boa ore already obstructed by emboli. The cause of the frequent 
nee of emboli in the Uiwer lobes is this, thst the embolus moves 
Bwly tluin the bloofhstreHm and sulht^res to the walls, thus to the 
lowest part uf the wall of tin; ti-unk of the pulmonary artery. Ktiiboli occur 
^ual fre<juentty in one ajul the same branch of the pulmonary artery. They 
much oftener tho right piilmonar\' artery, because its current is 



202 



CMOOUSW. 



gruatL-r, bt?cause tlie left is covered by tlie noita, aiiJ its stream is tl»»reb/ 
HomowliHt huuU^ret) ; liiiHllj, hecaiisti itioMt Hirk ]>oo|»le lie on the left side, 
which thct-cforo ttomcirbat ooutracts the left holf of the thorax. 

If A vRuel V obstructed by one or mora emboli of not too great tixe, tnil«eqtieD( 
eui]K>U5ra nHII mortl^ affect the saniQ tokmI, beouiM its wnlb are separated Ij the 
first emboli aad become more tbiui uonnally disceiided. 



In raro cwtps emboli trnvol in & DinK(?TiON opposite to that of the blood, 
frtreaui, e.ff. from tho right vi-ntricle or 8i»|>eiioi* cava into the be|)Atic vrins. 
Tbis is the cnae in those diseases of the reBjiiratory ai.parfttn-s vhere the 
iioitnul iiegutivx* pressuri? in the tliomx ik temporarily or p»^i-nianently 
chniii^fd into a poi^ilivc prosauru, A6 in all duieaJieis characterixed by cough^ 
in capillai-y bronchitis, in pleuritic ctfusiou», etc. 

After M\oESDrE. OnrTEii-nrcn, FREitirns, and Comr had experimeotAll^r de- 

monstmted thnt lit.>(li«>« tqnickKilver) intnxhiced into tho jagnlar rein crrntd reach 
the hepatic wins liy meanj* of hktroukauk rrKUKNTs, FIei.i.kh (If. Ajeh. f. kLn. 
Med.. 1870. VII., p. 127) showed the dfttn*?, by an cxi»criiu«iit with wheat-giita and 
by a patiii>lo^icii-niial<iinica] olMcrrACiou iu man (cancer of the ceuurn and various 
lymph -gtundu ; imiiciiriitiH eubohix in » hepatic retn). I itiyself ttaw, atf mtion haTing 
been drnwD to it by Thikhsiii, in two oases of thromboBU) of Uic JmyuJar rein after 
anrctcal operatiouh, hepatic without puliuonar}- alMcesBee, which were exphuued in 
Bimibir tnanuer. 

Kiiiboli, from the beginning, obhthuct thb vessel waoixv ob oslt 
IS PART. Tbo ouitmlua is usniilly arrest^'d at a part where tb*^ vcsftels 
divide, oi- whure tho diauiytf-r of tlie vessel is Buddonly rednoed by giving 
off branches. The larger [ilngj* usimlly go lo the |H>int of division, so 
that thL-y are, at tlie same time, Ht^mewlmt forced into bolh branches. 
At fii*Kt they lie hiow in the vessel (which di-stinguiHliuK tU-ni fnjni antocb- 
thonouH thrombi), and ilo not at Hnst comnionly obstruct tliu vcskcI com- 
plet^dy iu any branch. A HUle bli>od slill jmssta by tbom, although far 
less than befoiT, >*'> tbivt a Htiignation always r«8ulu bobind the enibolmi. 
New iirfcipitatcfl bpgin hnf<}re and bc^htnd ttic imiboluH, so that it becomes 
eucap8ul(MJ by fre^^h coagnin, and yet a KHglit ourrout istill romains. If th« 
embolus is very large and eylindricid and Hoft, it oluitrncts at firat ih© 
arterial bntncbeH completely, the artury contrncta about it^ and lM>bini| it is 
entirely emptied of blood; beforo the eoibolus, t.« , toward iho heai-t, a 
secoinhiry tiironibua is formed, at* in the case of Ugatui'e, as Du- upwanl as 
the next larger lat«iul branch. 

In olwtnirtion of very nmall vcsitelii in the frog, coafpilatlon In nnlformly abacmt; 
•ometimHH nJnu in mnu, booauHu the uilhrence of the vexMorn wkUb to prevent ooagnla- 
tjou Rorpadaes that of the walls to promote it. 

Tbe larger rndxili iiaturidly it'umiu in the lai^>r, the smaller only iu the 
fiuialtet- ve^iscU ; the &mullest, tinully, mti uttually arrested iu tbe tirat capd- 
larr net-work, which they have to p.-w», more rarely to be held in nuorher : 
CAPll-LAKT KMBOl-fSM, The»t' emlKjlisnis coiictTn sometimes the cnpillariett 
only, iH>[ue(iiues at the sumo time also the sitiullest arteries belonging to thitm. 
Tlmt botli tlie Bmallest vwwfls and the a»pilUrifs may become embulizcd 
has not only been proven by nuuirrnuK nutnpsies, but ex[»eriinent« with 
quicksilver^ carbon, starch, fat, wax, etc., have also dumousti-at«d the ]>o»- 
Bibility of thh> occurreuce. 



I 



308 



oli luving th«tr ongin in elie Yeiuft, •amnWy remain fixed id the Tnrioniily thick 
luiuiuhea of the jmliininar)* art«heB. The Kinii]lp<(t rmlioli of the veins, howcvur. are 
only amwt^'d in tlm [mlinonarr capUlarii-'s. or puss thi> Inngs, and roiiiaia fast in the 
next fullowinff capillary rf>},'ion diver. spleL-ii. kidneys, etc). Hnw Un-y paw tlie 
luugM i.1 tsxpUinf^I by the fact that iu inau.v pliici-^ in Lhe Inngii, a din-<:t cummunicn- 
Uou exiulK liutwutn the arti'hea and vfinB. wtiirh is set'n when, aiiynrbete, iu conse- 
queooe of a wu{.'v«tiun, tht< iutvrreniug braDuhes arc dialeudud {cide p. 14tjJ. 

Capillaht muoLi most fr«{]u<!ntly liave a primary origin, by w^jmi-atioa 
of the tiuL'st jtaiticU;a i>f a Ihrunibus. Tlndr ongiii is li--s.s ufttiU SE(.f>NDARY 
from M iit>n-cfipill»ry, especially a lining enibohiH, ft-oni which very fiiiR parti- 
clca bt^come Ke]>urat«d. Emboli orishig from oooguJat^^d blood aro eharac- 
t«ri2L>il by thnir external u)ipL*ai*auce, aud gi-eat resibtjinw to all itfugentM. 

Chaxqes in tiik embolics AKn IN THE WALL (IP Tiip. VENKEi. make their 
ftji^icftiuuct! if the functioiial diattirhanc-cs uiuaed by the eiuUt>lisni lira nob 
90 grt*»t as to cause iustatit death. In nirt! cases embuli aitr Ai(i>t>HiiiU), aiid 
the vt^ssel again l>i*ixuiieM free. Canalisation of the eiiilmlnM is ahmist iis 
mre, leading to the iKiriiieubility of the ohHiructed part, and woniefiniej* 
^vlng rihf to secondary emboli. Or thrj become uh(iamzki> like thtuuibi 
(pi(/n |i. 191), and »*o become altogether or in part buruik'isti. Etnb<>Ii luay 
too become som-B.SKit, and thereby lend to the foniiation uf hcivudary em- 
boli. Finally, they rarely Uecoine horsy or i^au^areovs. By meuna of 
most of tliMbe ]>roceau8 the chaouel of the vettiiel can, at leant iu part, ba 

C'liASiiEs AFFK'TiNr. THE WALL OF VESSELS are, ID the fiiift plare, depend- 
ent ujMin the absenoe of the triRCULATIoN. More recent (*x|>Hi'in»eiita! iuves- 
tigatioiiK hliow that bloodveshtOa, by a long interruption or urresi of the 
circulation in them, become as incapable of fuiiciion as tnuscIe-H and nervouM 
apparatuK, when deprived of blood. At Hrst the v^tsaelB are dilated; after 
a lunger time there* ap|>earK tcdema with emigration of oolorlesa blood- 
corpiiHcles; after a still longi>r time hanionhagoa, the circulation stops 
altogether and tlio vcshels die. At tirst the veins, then tlio capillaries, 
tiiiuilly the urlerieu, become the Heat of thene dislurbauL-es. 

ConrtiiEiu baa experimentally invuti^ed Uie above-deflciibcd ootueqaenoM oC 
H^^ rxrliixioQ of the hlucid from a vascular nxion, with respect to the wall ot the 
^^BbmI iti^lf. After ligutiug the whole loii;,'ue iu a froff, the circulation immediately 
^^KftMd. I'be veiwcl-wiill, uvfui after ftuir or live dayti of total lii;ntion, eliowcd no 
^^Borpholof^cal chiui^i-a \Vhi:u, from n fuw to twciity-four houn» after, the hfrntnra 
^^H remoTCH), the circulntioa is rery quicltly re-cxtAblijilicd : tlie veKseU arc iminedintely 
tfacivaftvr largely (iilatf-d, the btood-streiun very quick; but noon tbe arteriea fint 
oontmct. then the veins, and after one to two honrs tho normal condition i« restored. 
If. on the other hand, the lipituro bo loosened, not nntil after about forty-eiKht 
hoan. the diiaratlon of the veat^Jii and velocity of tho strenm will be tttill greatw ; 
tb«D the arteni>fl contmot, tho blood iJowk more clowly ; but tho veins remain dilated. 
JUkd frtiiii thi;iu ami Cniin the oapillariE^K the wliit« blood -co rpuscloB, from tho latter 
&1m> r««i oiriiunrlfJi, «:an.i*ir oat in lurfn? nuinVwrH. If tho ligntiirfi lie loosened aft<T 
sixty houfK. nnmerona (iapillary hiiimnrrtinges will bo found, lent from Uie xmalle^it 
•vtm: After four or five days of li^ration the tongiie becomes necrotic fiiinilar reuulta 
^L&Uowed lotjil [iKalion of Llio ear, toKticlo, and kidney in tho rabbit. (Similar cbaogea 
Hi^ise from arrcnC of the venous llow.) 

In the aoconJ placo, the changes in the vefwol-wall depend upon die 
jaKciLUriLAL OH rHKMhAL oiARAfTJiH OP THE KMBun 8. Inditierenl emboli 
effert no, or only tritlitig, changes iu the veswO-wall (thiclcening, sometimes 
gi-owth «ilh the Hiirrnuui.liiig tisHi)c«). If, hnwever, iho (-mbolns ia from a 
foul or gangrenouH i»«rt, it nmy give vise to a septic or gangienous inflam 
mmtton uf the vessels, which extends to a varying distwice into tlie aur* 



204 



EFFECTS OF EMB0LI61L 



rouading tuiiuos. If tho embolus has rough surfAC«s, e,Q, in sepoiutetl cft]- 
c*reoii» pieceJi of the valves of the heart, the infUramAUoa is tuore Woleot ; 
8ii[i|)iir.Ltioti is a not infi-e^|iient reKult 

The tUANdES in the oiigans *-hose artoiies ore obstructed by emboli«u 
dejjfnd tipoii the embolus itself (its hize, number, it* power to creute me- 
chHiiicjil or chiMiiicul irritatinn, n-xx:.)^ the kind of voHseU (fnnctiniiiil or 
nutiitivc vttHSolR), the tin-angi-niciit <pf the nrti'rie.s, the re-eatnblishiutiiit uf 
tt collateral cii'culation, ftiul tlie structure of the orgau itself. 

More rec*^nt expebimcntal isvestiration-? eoncenung these relations 
yield the follDwiug nistiltj* : Th«; ex|M^nnirnt« were iniuie on the frog, <^»- 
|it.'cuJly iUi tun^ue, which vras at the sauio lime examined mid'oscopicully^ 
and we^^ conducted by tlie injection of an eiuuUion of wax, colored blacic 
by liiru[thlack, into th>- heiirt or aorta. 

At firat, the artitries are cloM^d and a cnllalerul ciividatiun ix eK(jiblished 
in the (junx>uiuUng tissue {v'uh \y. 171). At the phice of the uhstniction 
the aitery i« usually bulged out, distintTtly naiTOwer before and Iwhiud, 
The contents of tho vessel no longer move, in front of and I>ehiiid the 
globidea of wax : in the former locality as far as the lateral bi-anchcs, in 
the latter for a varying disuince. If the embolus comes quickly, with the 
Hwifti)e.8.s nftbe bliiHKl, to itH locality^ there is before and behind it a column 
of red blued with few colurlettK blood-curjiuscles; but if alnwly, it is 
diireu forward by KucceKMve tbrustn, and thus a grudimlly incrfuiiiitig ob- 
fltructii>u is formed in the blood -stre;uu, the veMnel both before and Ijelund 
the obatruclion ix tilled with plaKUut atid colorless corjmBcles. (A coagula- 
tion of the blwod dues not ocour in the frrig.) 

The capillaries and veins supplied by the obstructed ai'teries, act differ- 
eutly. lJetw«'en the plug and tho capillaiies there is given olT an arterial 
braucb, wjiieU cuinmuiiicalcs with a bmncli of another artery (e«>llaten»l or 
anastomotie), thiiH through thesu' a sufficient quantity of blorwl i« supplied 
to the pei*iphcra] region onoe served by the obstructed nr(*ry, and its 
circulation goes regularly oa. The function of the closed artciy also is 
destroyed abiive and lieliiw im fin- as the hi(j>rMl hraneli. In like manner 
are the capillaries utH^ctriJ by enil>oli.Hm. If, on the other baud. Hucli oa 
arterial anastomosis is wanting behind the obstructed terraimil artvrj'^ tho 
blood behind the obstruction stantU absolutely still, as well in the arteriid 
bntnch alfccted as in the capillariea HuppHed by it ; also in the elfttreut 
vein until it meets with another vein which is supplier! by n n<>D*ob- 
structed artei-y. Aflcr a short time there ap|>ears in the Htrimmh-ss vwn a 
i-ecurrent movement int^j the cajjilUirios, and beyoud these into the artery, 
at first uniform, later rhytlniiical. This gives to tho jiart after a little 
time the a|>|X'arauce, to the unaided eye, of a djuk-red, sharply definod 
wedge. Siill later, a haemorrhage here occurs, and a u.kmokkiiaui: iNrARO 
Ti's ariseK, visible t4> the naked eye.* (The bteeiling is explained by the 
changes wbieh the vessels, espeeially the cspitlaries i»f the t'wbolixed 
region, have experienced tlirough tlie interruption of the regular bluod- 
supply.) 

The above-mentioned experimental results corresiamd in all easential 
j)artteulat*8 with path ologico-anutom leal facts. 

Four ditP-ixnt effects are therefore ascriljed to emboli. 

£ml>uli are altogether wtTHOfT EPKEiTf : they nMuain fixe<l, organize and 
grow with the wall of the vessel; the parencliyma behiml the obsti-uction 
remains normoL This is the ciwe, when behind the emltolui a sufficient 

* Consult Fbevost «b CoTAKD, ItaiiuiUiut$MiU ciribi-iU.—Oiu. JTCd., Parts, lt^< 
-fBu.l — 



I 



d 




mnecTTB of rstooltsm. 

art«-H^^^^^Btno»ia alivmly I'xists, or is estublisliPil iii a very stiort finir. 
£xaii^HMB ftruriO, rKpeciHll)', in llic liu-giM- hnuiches uf the jnttnioimiy 
«rti;ry, the nrt<!ri4's of th<! Iiniiti anteriorly and in the circle of Willia, 
le&6 ofti'ti the mesenteric itrtjerius, etc. 

<_)r, Ih-IiidlI t.he emholns, uaxoiiuni: npitoars iu its fliffcrcnt forma : ihis is 
oftcncttt the CASH in the exti-enutiL*a in thuir whole thicknetnt, or onty in the 
nkiu, and iu tlin brain. 

If the main branoli raiiplTing' \n ar^nn^ or many hirgQ Iirannhes of it. twconie 
wnoi l.r nlwTKi'CTKD, nijrl nutritive blood if no longer «n[»pli«(i, nor a suAicieut uol- 
lutf-mj cirrnlation i<« quickly «i(til)1iNbe<l. OANtiitKNK of thnt or^ao roUowH. Gun* 
gT^tic is the etTnct of aiuomia. Ucai'lefi. tbroiiKb ^ttmia in ttie cupiUariea and wlam, 
A hiKb dofTtOf! of cougcvliou and eveu extraviuMttion of bluud may Uika {tlucG, The 
•xtcut of tlio gaugrenc lit alwn7-ii imullut Lhau would bv tixpL'titcd from the aixe of 
the otwLructod artery. The gangraue is fnr the moHl jtart iiuiiKt and <Hlorb««, In 
the bmin aud RiiinaJ cord it HxixtH u tbe so-imllRiJ Rofrpniiij;. TiioHily M-bit^ In the 
«um>iiiidin); ti'wiM theto not infreqneatly exinta a hijfh dojn^o nf ooHaKTfil bir-pcr- 
lemin and ctch numerous biemorrha^ea, the Utter C8[>cciiilljr in tbn brain. (>»ii(frciiM 
Tcry ntr'-'ly occnra In the parancbyiiiii Coiiniiuim (.1. c. p. Til) (taw tottd emboUiim 
of the Ti!2ial artery, and omuieoutire total nocroiut of tho Icidney. 

t>r U-CMOKKHACEH orls«! : siiiK'riiciul hleudings, or bloody intiltrntions in 
4^Kt*>iidt'd or^us, hwniorrhugic inturclions in |iaronchyMmtA. 8uch occur 
moat ofteu iti thf; lurigH, Kploon, kiiln< v8, Uasa fi-*w]ut;ntly in ihu brain, 
rt^tinn. inU'Stiiial tract, ue%er in other orgiins. Boili prucesaeH, [^nirrene 
ami liB-nioiTliage, occnr only in orgiins whory, Iwlween thu ohstructiou iind 
the ru|>illarieH, in»in(Hcieut, inconKtant, or no arlori»l nuaiitomoeea exiitt. 
He«iili>n, lin-'mniThag(*s can occur only in organs whrr« the veins are vithout 
valves. These conditions are found especially oftvn in the lungs, s^deen 
aitd kidneys. 

Tmc terminal artorio* arc prcnant m the oririns named, in tbe retina, and interior 
of the brain. CerobraJ anoatomoww, at a dit>taDoe from the cirole of Willis, are 
inQoa«taDt and reiy smalt Thoj are oonntant bat much too small in tho last arterial 
hranehea of Uie pulinonarj" orterit'ii. the inter-alveolar arteries. Aoeordinij to R[ND- 
FLUtM-u [T^hrb., 187il, i> :lit'>). not only nil the main branches of tliH |iiihiioiiary 
urterr. but also those entering the lobules, running between two neighboring loljulea 
mm well u finally the aiaallCBl bmoches are terminal arteries. 

Hii'inorrlifl^c infarctions iire more often iioripheral than central ; they 
nre black-red. firm, homogeneous, or, acconling to the struuture of the organ, 
liorny, striated, etc. In their farther prugi-esa they grow pale fi-oni tie 
c«*ntre outward (or thia wuft |mle from tho beginning), and may become 
absorbcil through fatty metamorpboMH vith s\il>se<]uctit scar. Tliey less 
frwjnently entii-ely, or at jwints pas* into snp|iurRi-i(Hj, or ichorous trans- 
Ivnuatiun, or gangrene. 

HBcnorrhagic inforotions wero until reeently rcgnrdi>d as haemorrhages in conse- 
qnftnce of high gmdes of ooUatural hypcnemia : it wna believed, that through the 
sudden obfltniction at uunicroiiii cipillaiieit and of tho .sniallcst artericit anpplying 
them, tlierw arn«e a «tro»g(T hypf-nemiu and ni|iturfi of the central and peripheral 
cairinariex. reiiiH aii'I Hinulliuib url^iriiiM iL'HiiHcially In yielding tixHues, like the li)ugi>, 
spf«en. brain), and c^^ngulutlon of Ctie extntviuttitioii, O^iiMfKiu ha.^ shown, that 
tiicy aris? from a reourreut nioveiBciil of the blo<Ml in the formerly streanilpse veins, 
nod fxoin hieuionhuj^cs in the diMtriut onxiplod by their t-apillaries. With respect 
to this, dirL-et ol«Bervation above nil beara tchtiiuauy ; farther, timt the infarctions do 
not np|><:jtr immediately aft<-c the eiubolisni, hut only a little time uflcr ; tlien that 
in tufmorrbagic infan'tUm of the Inngs the arterial umbolun ih nut nituatcd exactly 
at the |toint of the infarction, bat Bomewliat to odo side. Besides, there ia a {re- 



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8TMPTOSK OF K^klUOUi^M. 



207 



it is, so much the earlier iluos ^an|;rcno npppiir in tibscnce of (i collateral 
circtiliiiinn. The niONt exttjnsive mid quickest «le«tniction of tissue follows 
emboUhiu of the cuf»illurie« in soft t^'xtnre* (ItiugK, liver, spleen, brain) ; 
th'Tv ariM: JTETARTATii' AnsoESRKS. Tile tissues lire lU'stroyt'd nioiv slowly 
in the kidneys and still more so in tlio itkin : hei-e there are foiMied firm, 
y»*IIowii,U white, pmnilent plugs, so-cnlled t'liiL'NVLE. lu the bones, nc- 
croiiis Inkes plHi.'v oiil>' ttfter a long (.iiue, the detid parts giiuliially becoumig 
h»o.Hened, so chIUhI bkijiieptra. 

Ill onoANs with a noriiLE rvstkm op ixhsels, Anietional and nutritive, 
eintxilisin of the nutritive veKscl»i iiffecttt the textui-e and function at the 
mui> lime, because fmietiou in possible only rhiriuj; norniul nutntion. Ju 
enib'di»tii of the ve*4s«-U of function, norninl tiutritinii ivtuains; bul the 
inni'live jmrenphTma often becomes atro])hied, nor infivi|iu_MiiIy with liy|ier- 
trophy of the interstitial connective tissue. Nutiitive blood can act 
vicariously for the functional, but not rire-vevifi. 

llii! (^oLi.ATRRAr. i'iin'fM.,\TtoN of parts obstructed by eiitbolisin is, as flaid 
above, of the gre.ite.st iniportnnc** with respect t<i the future of the orgaii 
afTected. Thi! tpiieker it Ls eHttiblished and the niin-e et^raciniis it ik, the 
less the anatomical and fuuctionnl distnrbiuice. It arises either fi-om other 
branches of the emboliied vessel, or from other vessels, but of the «atno 
kind, ur KnaUy fn»in ve>o>vla of an uUngether ilitferent i-hai-acter: bntli ihe 
former modes art; si-Mom found in the brain when* only large and very 
small, but no intermediate anafitomoses occur; the latter moife occurs in 
the Inn^s, in ob<<tniction of the pulmonary artery on tlie part of the 
bronc4iial arteries. In tliKeHRed veHHi-ls a ctdhiteral cireulntion is usually 
lea* complete. Tlie coliatei-«l circulntion alivinly i^i^raljliKhed am thereby 
iu turn be interrupu^, bo that the primary coa^ilum gradually grows 
toward the heart. 



In a cue uitcdby Vmrnow. themaia vesseJ of the whole pulmonaiylotw of adog- 
vai totallj olMtmct :<I l>y oinbolian, by (njecLioii of lar;;e pnrticIeK into the jugulLir 
vein. When the Duiinul died, after a half year, the aatopKy Hbowed that while aa 
(Djection-iiiass conld not bo drireu from the rig-ht 8ldo of the heart into th« affe<V 
ed lob«. the moat delicate iiijeetiou of Lhe puluioniu?' vessels could be obtained from 
the veiy dilated broDchial arterim. The lung it«elf was noriaal. 

The fjrpLrEMCK op emroijsm ox the wiiolk ohganism dependa: npon the 
intemiplion or abolition of ccrtjiin functions essential to ihe organism, 
(cinbolittm of the puluionury artery, of the portal vein, of the cerebral 
arteries) : upon irritation of the senfinry nerves in the atrected orj^an and 
their rellex action on otiier part« and functions (cliills, fever, convulsions, 
ii ' I : «|KiH the Kudilen lUininutinn of the cun-ent, and the recurring 

t' and plethora (congestion, syncojie, luijdiyuii) ; U|K>n S'jftening, 

gaitgruue of the orgau ; U|)Ou the hcijuelw of almorpliun (s('ptica;iniik), etc. 

SvsrWOJI? OP EMBOLISM. 

AutochLhonous throDibows differ from embolisnis iu that the consequent 
phenomena ariso slowly, while in jarjje endtolic obstructiims w itii fiiiocK, 
thn couf^eqaencea of the cutoff blood-supply appear in a (hiy. If, (?.//., 
cmboli^nn atlect one of the larger arteries of the brain (nrl. J'otiga <Sy'ri('), 
a|>o|>lexy inmiedialely follows, ».e., paralysis of the part of the brain afTect- 
ed ; if it-atfetit a large branch of the puhuonary artery, there appeai-a sud- 
denly the danger of sulfucation ; if one of the coronary arrenes of the heart, 
there follows acute paralysis of tlic heart's movements, pain, feeling of 
ioiiHsnding aiuubiUtion with retained consciousness. A great portion of 



20S 



SYMrrosis of EMUoudM. 



the sndJeit omauroscs in jtrtpinitt, piieipL-ral ^ver, acute rheumatism of the 
juinUi, Hru uf uu embnliu natiirt!: tbtdr iiium*dmte cauuH ih thu acute eiulo- 
eartUtiK often cimijihcatiiig itioKti jirocesses. Ju emlK:>lio Dbittniclioii in an 
oxtreuiity, iiitirt: Kiiildcniy HjijH'ar Kt-vcre ]iaiu, a feeling of uumbueu, 
Homutiiiies a cliill, Hoiuctimes loas of the sense of toiiok, with genenl 
[AinOt puIfneK-**, and a feuling of cold, weight and jtaralysitt of the muiielfls. 
The ]>ul»e beneath the obstructed part is no longer felt, above it bisats 
with so much otrongcr impulse. 

With rpApeot tn thn Inrnljty of att.iio.tc, the alreodjr mentinTiml freqitencT' of embo- 
lisms oil thi; loft skle in imtiortint. HinboUc pftraljsei of tbo brain nrc examples, 
because tbo left bcmiHiihGii; in commoiily utfacned, mnstl.v the riffkt half of the Uody; 
embolic pamlj^u of u lower cxtrt^mitj' U usually ou the left Rido, 

If death does not imuiediatuly follow etubolitmi, a recovery can take plac* 
after tliH dntt sevorp Hympu»im, which ttro often att«^nded by a diill. Even 
tho most flevei'O and mo^t dttiking Hympt^ims (parapK^^iu, heuiiplegia, motor, 
sensory panilyses of an extremity, attucka of dyspUfUd, Hvmptoms of angiiui 
pectoris, etc.), can, after minutes and hours, entiroly disappear, if the tei^ 
minni artt-ricK hv not obt»tmctt;<], ant] if with correspandin;^ i]uiuknt;Kii a COL- 
LATKRAL L'iiit'tTLATiON be nstablished. Tbis can rarely be witircsly over- 
looked during life, Tiie disorders, which ni-c manilested asi external symn- 
toniH in the (>b»truct<?i| rogioD, nro therefore very ditfcnjnt. iKcbremia u 
often Kfj c«iisidi;nihh', that the veins also immediately lone ihidr [Miwrr to 
carry the blood onwanh In ihe extremities, cspccuUlyj n bluish-ri'dueiH 
appears eoim aflper the timt paleness, also some (oJema, »aiall lia>murrna,;!;f^ 
even the rittiiiuiiou of v^MicteH ; Kumetinius true vtmouH throndxiKia. Ou 
the other hiintl, through obstruction of a small branch, no much lihx>d may 
flow into Iho vciutol» tifmr by, aa to give liso to symptoms of iutlauimatioiu 

Theremay. «.jr.. be an emboSioobttnictioD ia one oarotfd ^^''^ ' '^ ^ tn canal, 

and a renultla^ paralysia of ODO sidfi ; but it will juitt lu qai< 'io« thn 

blood soon b^jontva suiiplietl from the other Bi.k thruug!! L ..iMU, nuJ 

aliK) from the vertebral and baxilur artiiricit. But if the eiubikius aff<!Ct4t the re|poa 
above the cirde of WilliH, e.ff., in the art. fmmi St/ldi, hemiplegia foUuwN. 

The usual termination, however, in the case of large and comph-tc art^v 
rial obstructiouit, rspecially of the hraiii and extn-mitiea, ia soi-tesing or 
n^ynRKXR, wliicli for weelc.i and months procwda continuouiily to the 
point of ohtumtion, 

Tn parts pmirly snppHf^il with ucrvfw (livor, spleen, kidneys, most rauroua 
membranes) the moro important syujptoins are wanting, or the eraboUsms 
are entir'-ly without symptoms. Jiloody ex()ectnmtion frtviuentty aj»iH*nni 
in ronit<'ipicnce of coltabui'al hyiMTa'niia in tlm Uni)><{ tlniieudent ou emljulu!i, 
in the kidneys, occMiftional hematuria. Symptoms of jMirtiuI pleurisy, and 
peritouitiH, are freijuontly present as a conseijuenoe of peripheral iJiCaro- 
tiouB in the lungs, livar, and spleen. 



In embolism of the mM(»ntoriR artnripd, thare occur oopintm, o\<r> '-.f iate*- 

Uual lia-tiinrrlini^'jM. abdominal pain (iic)mi>timt!s like uoliot and wi ■■ i. fi.unU/' 

trympanitio dlMti'Ution of the ahtlomen aail peritoneal exudation tCutUf, Oi'i'iit«ZEll, 
QBnuAiioT, Ki-A!«>t ^ri,. Hkoaki. 

H>my ijahrh. f. K'tcrheiUc.. ItWlM. I., p. 301) holds Wn-LAN*9 erjftl*-/H't fj/rf-wwAt 
and Sfii&SLKlN's prU'tain rAci/frt«i(iV<i, also lU'KTKn's 'Kiin. it. Ofietikkri/t., IrTO. p. 
9iifL) fiify<trtfiHti0 $}itu>pUUui ac'ti'i (aa<ae rbejtnittsn of tUe joiaU), to be of om- 
bolio natare. 




BTWreiMB OP KUDOLtnir. 

Aoconllug to ItABTrAN {Brit. .Vtit. J., Jftu., 1M9). obsiniutlon of email arteries and 
Gi^)Utnrielt Xij white blooJ-corpnouIwi tn the gny matter nf the hrain in intetue 
febrile tUncoMO, m the cautto of tbu ilelirititii. aud BUtpor, ami otbttc sjrtnptoma of the 
typlioid «l nt«. 

Fftrtlier iinportAut difference» in tho symptomatology arbe, acconiing as 
tilt- etnliiiliKiii ain-iix tlio v^-hshIs of nptrition nr PtTscTins. With reHjwcrt. to 
the hittvr, th*" ptilmoiiai-y nrttry diieliy is of iiiU',rest, 

KiiiIhjUc uWi'uctioiut of itfl smalU-r biiirichcs^ are of all oiiilxilixiiis thu 
vnifil fixHiuont, but alinust alwHyB entin-ly without tjyiuptuius. AIjhi whcu 
larger branchia of the jnilnionary nrt<Ty become alwtructoti by (»ni!w>li, no 
syniptniiia ii|ii)oar. In ihts ilcnd body ihv aflVcted |mi'ls of the huig8 ai-e 
aometimPR [lotos^tentially chaiif;^tl, because the bi'ODehial voft«els dilate vica- 
riously, soiiictiiiies iwti ana-mic, oollapsed, and >>oniewhat emphyBcmatuns ; 
Bumetimcti liKmuirhaglc infarctions aru found, Hurroimded by collatt'nil 
hy|w?rvuuc tivauc. Only wliuu numerous small braucli<->H of tlie ]>oliiiuuai'y 
urtt^ry are eloaed at tho same time or noon aftor one anothor, or when a very 
large brunch in obstructed, wlieu a large part uf the lung is tliuH Huddeuly 
deprived uf blood and on that account «o niucli the nuue bh«Hi Howh into 
rtlbcr parta, do marked sviiiptoicui ap[H-ar. Suddenly upiireu ap])eurit, 
and after longer duration, in consequence (if cnllateral hypenemia, acute 
a'd«ma. Percusnion is normal, but when iwleran exists, auscultation reveals 
£ne rale?. The in«pirution ia free. Ttie pulHo is »0">etinie4 HUiall, the 
and mueouH niembranea aro very pale; tlio RRcond sound, a)ul tho 

art's impulse are increase^l ; the extremities hecumo cohl, the musclefi 

ik. IVath fullawa from anreraia of the ftpiuiil cord. In the autopsy 
halves of the hcjirt are found in diajirou^ the left cavitien nnd the 
piUiuonary vu'iua empty, the right cavities lilled with blood, the cardiac veina 
strongly diAtvudciL 



SrDDEM DEATH TS SKVERK RMra)M«»M OF TflB I'ULUON.XRY AKTEUY llepeodl 
apon th« wa»t of blo<.'nl-nn]i)ily to tlic ttr.iiu and medulla oblon^'atu The pbciiom- 
eua of deatli from tb« iutltruet iriterniptiuu of thi; arttirial blixul nttpply tu the Kruut 
ttcrre cuutreti, nru ulLogeUier ideulii^al, uud the inc<.-Hiuiii<tn of tUnth \x iu both coseil 
the aioiic. Id thix it is a i^rif^Liuti iR-iLliur of MlfTocntion. unrof pnmlyi^in of tho heart. 
In ejtlenntvt) em^KtliHiim of tbb pulmunarr artery, the first quite coiwrtaiit pbonnmenon 
ia the extreme palfncj* of all ^Twhlc p.\ri* of tbu b<Kly Icoujunotiva, gums. lipB). Tho 
white braiQ matter \k entirely empty of blood ; tbo veina and veumiif KiiiurtcH of the 
brain are filled with tduod Thui iKUeneM ii imiuediately fulluvretl by o^unl&ut 
tertMtdo oxteiuion of lb« Utub«. iuvuluutary eracuatiuii uf tJi« uriua aiul feet^, and 
rery deep ii»»iiirat<trj- inoveineDts (PaKUU'b experiments). 

Thi) svMPToiia OP CAPILLARY BMHot.iSM have until now boen almost only 
anccNtiible to ophthalmoscopic examinations. 

Kmbolisni of the pulmonary capillaries with great iptantities of air or ot 
liquid fat iiliui li(!K nt the foundation of a number of cASBB OF srnpRK DEATH. 
The >:atiH.»B of cmlHdiHius of nir are injuries (usually woiiruK rarely uleeiit- 
tlouB, etr.) of the larger veina in the h)wer ]mrt nf the neek, of the upper 
part of ihe thorax, of the axilla, rai-ely of the uppei*, almost never of th« 
[owt-r extremitieB, with aapirrttion of external air : of endwIisDis of fat» 
extr'ti^ive lax:enitiona or contusion!* of the suhcut^ntMins adipftso tiasuo, and 
^ally of iho marrow of Iwnea. From embolism there ariam aii in- 
Betent decarbonizatiou of the bloud, and especially a Btoppagtj of the 
auiyplv of artcrhtl blond to the spinal cord. Small r|uantiLio.s of air and of 
Ikt aro probably ditfuaed, oxidiwilj oto^ and for the most part therefoi'e un- 
i^juriotu. 



Contratt AjrrssAT, HrrJt. t. Cintrothift. awid. rfn Fair dan* ha wjn«. 183S ; For 
RKUILLR. Mkiiciku, Bkck, O. WiciUslt, Jfandb., p. 93; the Author, Arck. t 
HtHJc., UI., p. 341; VL. pp. 140, BOS. u. 41*1; BuaCU, Virch. ArcA.^ XXXV..] 
3a I. 

Besides. ooDoemii^; the symptoms of embolism of patrid aod gangrenoos mAti 
oonoerning ''mcustoaeBr*' tide Qangrkxic, Pyemia, eto. 

The symptoms or kubolism op the mmphatk's are not yel kuowu 
Besides, embolism can nccm* only in subortiinat* |ir(jportioiiR, because tho 
vesuiols enter tin; lyitipb-gliLiidit bi^fun; It'rmiiiutiug in tko larger branche 
especinU; t}ic thoracic duct. 

Oou«alt. on the other bftml, tho opposlnff oxperimonti! of ScinrstGaEB-SBrDKi 
Stud. d. pky». /n*t. 7u Urediu, IHlfl. 1. R. p. (H. 

The DIAGNOSIS OF EunoLiftM dqieiuls : I, upon a knowlwlge of tlw oonr 
of en.bolisiu ; 2, iifKin the proof of tim (lirniiiution, or of lh« aiiUdeii cutii 
disappi'Aranci' of the tlii-omliosis serving ns a sourcp; 3, upon the Appenmncvi 
uf litypicni chills, with or without cnhirKfineut of thu spluen, with complete > 
remission of tli« fuver; 4, upon tho sudden aptH.'aniuoL' of ii si-rii*!* of di» 
tui-bancett in rhe function of an urg«!i, whiL-h find in emtKiIisin ilieir fidl, i/ 
uot also their excluidve i^xjiUinntion, and which usually apjjoar from tbe 
first with all their inlnnsity. and either h:a*l (Quickly to an unfavorable ter- 
niinHiiuaf or quickly or slowly, in their (krlher progress, assume a somt- 
what more favorable course. 



4. U£MUltKnAOE. 

(RematorrhfSA ■. Proflaviom Saz^ainis.} 

C. J. MBrnii. fi)/Mfnn. Htindh. zvr KrK-mntnimt und HfUung dtr IlhifliuJM;^ We. 
ISIU ft ISOri.— Vllicnow, TiVfi/t. -4r.!A.. 1S47. I., p. :tTJ)-. WOny.n. Veril. VIL ; 
Hnttdk d. */>fy. PuUi. a. Thft:. I., p. 227; Die kruuMfi.. (Je--*fJ**ruU<. I., p. 123.— I 
Pbstalozzi, i'eh. Aiwnr. tjiuria d^r kleintn Ofhinmrtfrten nnd lUren HnmiMmsn- | 
funis mit Apofile^if, WdTthoTg. imu. — Pa«kt. fj'fnd. M«*l. Oits . 1850.— HTlcn, Attn, 
d. litrl. Chtr., 1852. IlL. p. 11»3.— UooanEHH. Ufh. d. jfith. Verh. d. Id. Jlims^f,! 
18M.— ItECKMASN. I'ireh. Areh., IWil, XX, p. 227.— ItlNDFLKlnrn. Aivfi. d. //inU.J 
iyfi:i IV., p. 347; E-rfM-fimmUtl atud. fib. d Jfist"L d. //<y?«. IHtW.— O. WKOEIkl 
JfitHiib. d. nlig. w, ffifr. Chir., ISU.l. I., p. 119. — CoTwmlt be«i«lo« the surjpcal work*] 
of BcLL^ DoTKO, Vklpeau, Billroth. Ekicuskn. Gross, Uuluks. 

By the term h^cmokruaoe is understood tho escape of blood, throtighJ 
various pathological couditious, from its natural reuervoirv (extk.vvA6A-J 
Ttos). This takes place as well iu the heart as iu the arteries, veins, audi 
capillniics; hence wo have cakpiac, aktrkial, ve.vouh, aitd CAriLLARrl 
hwmorrhogcs. FAitKxrHVMATors hjemoirlm^r'S are tho.s<) which situiilu-l 
neously proceed from numerous HmiUi urt'.Tiul and venous branclMS, and i 
c-apillaries. 

Ev«^ry LAHOK fixtmvasation of hlood, i.e. of serum and blood-corpusclea, 
also every escape of a large quantity of i-ed corpuscles outside of the vetisets, 
presupposes a buiture ok Tim ve^skls : •' H.fiMuHKiuoB pek icuRxiy." 
Since thi^ is often not demonstnible, eM|MHdally alnittst never with roepectJ 
to the capillaries, rarely with rcKpoct to the snudl art4<nes and veins, Uioj 
demonstration in doubtful cases of a great qnanuty of k£D blond-corpuscles i 
outside of the vessels is snfiicient. The 8MAU.RR and smalleRt ba^morrbagoa, \ 
especially from the capillai-ies and smallest veitzs, niay Occur viTnotrr rUi- 



H-EMORnilAOE. 



su 



BLE iJfJUKT TO THE VESSELS. Tlic bloo«l-eor|iuscles have tlie vessels, nccoiifi- 
iag to Gome, by a kiiul of trickling proeess: " njiHOiutUAUE pkii piai'EDI- 
ais " ; Hfconliiig to otlit-i-tt, tlirnitgU vpr,v fint', piX'fortiKil o|>t^iiIiig8 in the 
walls of the veHM-ln {ntoiiititu) : itLEEOiNt; per axastouosix. 

DKMKTitii'H awttiiTiCfl, lieRiilf-ft thn throo nomril kinds of hipmorrhage, one per 
diat-rr^ii, (by niceration. ct«. i, nn<] miottior ju-r ^Ihrmin {hj •xownAf*. etc). 

With T«H Pin. loMifi ftinii :iiitl mjtnuorof ih« ftceurronoo of ti.KMottltllAiiRfl Tniiouan 
rsiNJi'KKD VK*'BEI.fi.tipiiii(in inslill diviilod. Acrantinp toSmu kuk, Wifti t^U'jubei:, 
Itttl. the process is an aciivk one : tlie cnpill:iry wall, which, ncwrilinjr t<i liira, is 
prolupljuiu Id tubulnr form. »nd c.-v]tu>)l« nf niOeiwuOeDt itUeruatv ooutraotion and 
JilaiaLiun. Uiket up the lj|(H:>il'cnqiuMjk-9 auil fortwft ihom out, Aoconling Ui OotO- 
HEIM irtWr [iillamiuatioii). the process i* nr.vwtTi; oue ; the iiicrtn»tfil bloud-prcBfeure 
dilitUts tbu inccording to him) profonn<.-<l opeuiugsi in the veftscl'a wall, niid throug;lt 
tb««*: the hlotid-orpiVBcIes are pre«ied out. 



Ruiitiirc of tbn heart autl bloo(h'fs3cl8 nfFects in most casos au. the 
Trsi<_'B or mt'tnbranr's. Only in Hi*.' nrtoriw, t'«pHei«lly the aorta iind in 
Ui'? arteries of the btiiiii, dues it li;i[jp<.Mi, tlmt ouly the intima lUiJ me<liu, 
uiiilcr t]iKse eaiiriitioiis al\v-fiy« flf's;pnerrttej. are riiptuifil, wbilo tbn ailveu- 
titift reiimiiiA uninjiii'cil, And that the blnml occnmnlutes in (lie Hpaoes be* 
twwrn tbe hitter and middle cnat (so-caHHd niSf^EUTtNO AsrEHiKSi). 

Since tbe ext*'niMl MirfMce of ilip ves-sfls in almost all parts is con- 
linuoiiKly conm-eUfl with tbi> \vxr\» .turrniiiuling tbcni, agrfiat haimorrbago — 
ifwL* excf^pt those n|M>n the siirfacp of tlio btxlr and in the cavities — is 
only possible, when the blood can collect between the tissuca and the vc6- 
5el» .ifl in pnrt« which art^ dense, or whcji the snrroumling paii-s are at the 
Bftme time lacerated, an )iap|iens in aIniOKt all t)ie softer organs. In the 
■ouilk-r and smallest hceinnrrliages lacerations of this kind ucjd not occur, 
nncc tliO blood -co rjiusoles pas« into the Kurroiuidiiig lynipbatics (lymphatic 
sbi^th). into the preforinetl spacfs of tlie cimiieutive lisKuo and into the 
lymphatic radicU-H, and, nndcr certain 011*0) matAnces, between »nd into 
•pitbelini and glandular oclhi. 

H?morrhagM«j are distinguithed as external and intornid, with respect to 

WICALfTY OF THE EXTRAVASATION. KXTEItNAL M.EMOKHHAUES are tliOSe 

[fOecnr on th<- Huifaee of ihu Imdy oi- on the surfatvH of mncona mem- 
lying near it and \-isible (nose, mouth, vagina, rectum). With 

respect to hiemoiThagt?H on the surfaw. if they occur slowly with frecjuent 
' rt'petitionB they receive the name of utoouv fluxes. 'ITiey occur on the 

siirfaue of the Aktii, when nurmul (bloody Rweat)^ ax well as from wotmds 
' »nd «lcer.i, but e.spc-cially on mucous moinbi-anes, rarely from gUnrl-dncts. 
' l5TEKaiAL hiPmonhages are thoMe which occur in pre-existing cavities and 
L^kDaltJ, sonietimetj in the puivnrhynm of pnrtx, and nsnally do uoi extend 
J| bin thfsi', or to a alight dlKtAiice. or only afbi-r aome time to the surface, 
rftom this it apjieni'S timt no slmrp bouiulary exifits between external and 
. internal hremorrhage, 

■tfThe escaping blood is either rt'RE. or — and in all proportions— mi.xed 
^^b Beer«>lion» and excretions (bloody nrino, stiiol, teai-a, sweat), or with 
^^■c)at«K (s()-cnlled lin.>morrh>igic exudations). 

^^ph*f following kind.-* of hiPmorrhnge are determined by the relation or 
' TITE EXTHAVA.SATios TO THE TisBi'Efi. If llifi hiemorrhnge is small, moro 

bupcirtictal, and cxcrciiM's little prcksuii* upon the ti.ssues or slightly lacer- 

at*-?* tbL-m, it is tormcd sfFKrsioN, ha.'morrhagic iutiltration, and if pnricti- 
E<?riiYM08is. If the eHTuBion of bIo<Kl is large and connected with 
,t sepanttion of the titwuea, with little or im deutvuction of them, they 



CACSE6 OF H£Ui>3UUIA0E. 

are culled njSMOHRUAUli: i»t'.vKL-T]0»ti; ui\ If the effti&ed bluoJ fomiA 
tumof on a fiurfnce, itLooD-TiMi^ns, dlood-boils, H-€Watomata. If Kloodt^ 
is c-iTusctJ in Uxrfin qimntitv mul tin; lis8U«:fl twe iloetroyod, it ifi fcnown ob i 

H^MOitUJUUIC FULIH, BLUOU-SI.OLIQU. 

n«MonnitAOF.» IN VAiiious rxnTEi op ihe body receive iuimo« hy oombinli 
either "iI-BMo," or " n.tWATO." or"uilAGK." with the name of the part: ^.ff.. in 
tbu uU-rvw att bwiuatoiiietra (mccuinulntiun of Muod in tlie ut4fniK), or nu^Lrurrbiipia 
iflon* of IiIikhI nut of thf. nxaran) ; bv hwiimtMhorjuc in nnclemtnuit hasnotrlinffv iut' 
the |iU'nnil itavirieai, hj- lin>inAtoec1(< t>uit intu tho va^nol meniltninti nf ll>" U-stii-le 
by pnpiiiniirrhii};in haL-niorrttU)fe into tho liiDgfl. Uwidos, the ' ' ' muLa 
bloo(],r urine, hxmittcmesifi. bloodjr vomit, hmDOpt^rak or timmoi \- »\n 

etc. are in cumiuoii nm. Hv rrttiTRA ur rp.TW^nT.K (KjHitK f<iiiiiu. i^ m.,- can 
bjf tlua-bitC(»| IB umit'n'UHMi. tmiull. piir|»l«-ri?<l, ntiitiOecl (fffu-iitii* of blmnl in ill'? *ki» :— 
\^ Uii;.i..i-:na, Hii escape of black lil<h>il hr vomaiii^ tor »>tool!ti ; by ii.i-^uituiujuilw. 
hiCraonfliogefl of the wctuni ; hy nfil-* rrntnttt HowU atooiB. hy KI'ISTAXIW bl'^edin 
from the noiw. Lar^iu baiinonhii(:»* iu I'xturual imns. t.-t(|H.-(jiully of iLe cjitivini— ] 
Ue8, wberc they uru cuoDcctod with oii oUiorM*iM: norxoal artci^, ore naUud rALst^j 
or TKAIMATIC ANKmiiaMn. 

For luDmiirrhagio foci, or for jU] kimU of hnsmorrhnfff many niio ih- — --' * m- 
PLttXir.* This wor<l, however, refers only tothepu'lii<'ii intt»mipttfni o: i"n 

of ftnorffnn, nni) fince this is very frcijuent iu the braiu. but not alwu^ , < ut 

on cSasioDs of blood, the word ia bett«r usud lu tbs Ut«ral seuM. 

TliL' QUANTITY op RPFl'SEn Bl.tlOD vunes ill tiVQi'y coiKMvnble ilegree. Iu 
many cMsea no gnmt a qtmiittty of bluod ii> |>oiirt><i out in tho shortest time, 
that dtrath fuUows withiii a fww Becouds: e.tf., in ru|jture of the heurl, uid 
of the Ui^ur, mostly tirterial, mi-ely vvnous vessoU (bursting of aueiirisuift, 
corroftioii of the gastric iirtenen from ulivrntiou, &tc.)^a|»o]dt>xy in it* 
old smine. Or thei-o ltHj»|HrnA nn elfusiori of blood only by rhxiph ; utiUi- 
culium snngninMf or ftftrU^ us in ihe nose, inU*stines» et4\ Or, only Ainglti 
blood-<K>r]nisch'8 appeiu* by difliMMh'sis, or tlirongh jueforrmyl very fine 
(i])enings tlirongh tlic rapilUry wjtll or wuIIh of the Hiniillf-Ht veins, mi that 
the hn>morrhitgc ts rocojjciiaable only throtijth the microsfope : this hii{i^>t*ns 
in congestive and in mecluuiical hypertonia {eiile p. ISU el 186), in hyptr- 
Kuiia of inflaintuiitlon, iti pnniary hH^morrlingic uxutlutious. 

HannorrhaEefl vvlth escape of blood by drops on iometimea vixible oii tlie eurfaoa 
of grauulatioiM and villuuH vuneular nevr-foriuatious (f.ff-. caulirlower nYOwih&iu ibm 
vagina) to the noked eye. They occur, ocoonliox to Vmcuow, souiutiiueii iiJ»*i iw» 
Uic »;urfacu of Inrgu animnHtnif, cy,, of anuurtinnii of the arch u( the a»ila, wbcn 
they have picrcod the vterntim. 

THE CAUSES OF ILSHORHUAGE. 

Th^y affect normal tiwup-s as well as new-formations. 

1. Fkom FourEs acting rxtehkallv to tiik vesseia Uare arc cloiisod 
the diiftM-ont wousu.-i of vessels, out*, 8tt»b«, and iiijnricti of all kinds 
(most of the- ueciilonUil ur inteudi-d injiirlcb of the sofi pitrtH of tlir tnink 
and exti-eniities, contnsions, lirniMes, fit*. ; similar injurteA id" the Umi-s; 
fnictnririt, (>bc., of thiMii ; ri;phalhnMniiti>nm ; hieinatoniu of tlie muKvles, 
e.ff.y of the sterno-cleido-mastoidens ; that of the <'xt«nial ear, othivniu* 
toma, especially of the ijisune; wounds from Hwallowing Kti:irp or pointtid 
objucta; thuHH of tho ukin and niucuui* uivuihrauea from friction, the action 

• This per\-er+*'d iwo of tho word Aropr,EXV, so common fn textbooks n 
hoR proved moBt miftlea/ling to atiidiuitit. Pruvioua to 18'JU tlio word " 
OB it should bo. to dcnominntc a ^oup of pymptoma, wliiuh may be c:^ 
oaorbid conditions foot hsmorrhai^ alone). — IKd.J 



^ 1 ».,_. 




Oy n.EVOHRnAOE. 



213 



' sub«tancefi producing excoi-iations, etc., eBpociallj in the urinarj- tract 
(calbetcr, calculi), iu tlie lowei part oF Uie inteatinal canal (Imnl fect's), 
in the H[i[>er part (hy inlMHtiiial woi-iiih: tinrhtfttmlmnum- tfnoiletifife — vufe 
p. 131), in th't g)-tii(i(l.s (»ul»cuttiti(N>ii8 )>:«!»)< irrli)if^>B ttitil galling fiviin 
coitus — h.'einatoniii of the vnlvji i'mm prrssuro uf tie hciid of the frptns 
iu ^wu'tnri(if)n) ; hy ati«;tcliint; atwl t^-Hi-hig, I'sjiei-ially of the granular bui- 
^ce of ulo-t-s, lu uf thu lu«-t;r pai't of thu n-cluin, of th4> cha|i|H^ Hiirfnce 
of the li|):« auii httuJit; in tht* bribing 0|k>u of canccrii ou the surface of 
th«* Klein and mncons mcnilimnpii. 

Throujfh traumiitic cantv'H ia exitlainml tlm uri^n of Inimiatocele from 
hy<lroi>4-1c, foruuUoma fmtoiiiirn from it hy|i|ninia, ok wi.-1I on thn blooOv mix- 
tures iu uauy iitriuuoua, st^rouo, luuooua luid i-olloid cysts (eoK^ailod h»ma- 
tooys tides), 

Sxintsii MrS'TLAR MOVEHKNT9. ftfl sttraiiiini* at stool, snixiKinf;, ci>ujrhingi 
«.ff. in whonping-cough, ai'c oftrn fiilluwf<l by rupture of vessels. Sonie- 
times tin- ve^KidB or oreitn<i were picvioiiHly aflectod «.(/., rtrong bodily 
muvtMui-nta raiiise hivumturiit, during the t^xtsti'iice uf renat anil vesical 
cuJcnli). Aflor gent>ml cunvuUions tli(!re art* fn?(^|uetitly beau iu tin' dead 
body small ttubBoi-oiia uad otlicr ha.miniThugi?&, in tc-iauic spaRUi often Itietaov- 
rhiigf>ft ill ihv uiumcImi; ifveu in thu akiu uf Uii:< tace uf Ihu liviug aflor 
scTttre i^pihiptie cunvultiiunA. 

Hftre ftlho belongs thi: inflnonpe of a deeifHSo i»f atmoftpheric prpsaurp-, 
aft in uy he set'ii, nmler .cnpping-gliistM^H, Jnnod^H boots, and sometiuioa iii 
thp ciiiubiiit; of mouitUiiiiit. 

2. DlMIMSIIBn CAl'At ITV OF BESISTAJfCE OF TIIK. WAI.l, OP TIIR HEAIIT AND 
VKSSKLK, OKfKMlKNT l.'I'ON original or acquired rilANUKS rS TIIKIII TKXTirRE. 

Here bfUmgs iu tin* fii-st place* the long excIuKion of tlic blood fi-oni a 
VBBculnr region and tho nraultini; aoftrning of tlie vcHH<-l-wall in end^olic 
proc4's8es, etc. {vitfe p. 203). Under this head belongs uIhu iuRuniinntory 
and gaugreuous hoftening and futty uieUimoiidiosis of the cli'oiilftt-ory appa- 
ratub. Thus aiitje ruptureu of the heart from acuk^ and chronic myocar 
ditis and Uftm fatty ini>Tahn>rphowis of the niuwnlar anhstanci* of the heart: 
ruptures of arteries of every calibre from chronic endarteritis ami fatly 
roe tarn (Mphosis of the iuleruul and middle coats, sciinelinicfl with prior 
aueurisiiuiJ dilatatinn (in the hraiu, in the lungs, etc.), suni*<ltinr-H \\tt)iiiut 
theM: (as in hieuiorrliagie infaretions of the liin^ in winiiotr adVetions, 
etc.) ; ruptures of vein* in parts destroyed by giuigreue, etc. ; lupturo of 
the capillaries from their llitty inetantorphosls. lt('«id»*K, all young vi^sseU 
have very delicnte walls : hniei* the fretpient ha-nmrrlmi^rs in the new-lK>rn; 
the bloeiiiiigs from the (piickly grown vejwls in intlautinaiion (in puchy- 
nieningitis, the eaUHw of the intemieningeal apiijdexy or of Ineniatntna of 
thf! dnra ninter), in pleurisy, perieardilis, i-te. (hieniorrlotgie t'Viuhitiuns), 
in retro or pt-ri-utirrine ha^nlatoeele, in gi-anulatious. Flimlly, hiL-iiiorrliages 
may appeur from diminished cnpueity of rtrsistancc of tin* tittKues surround* 
iug tliti vejwela, e.y., of the niuseIeK in waxy <h'gencralion (nniscle hiema- 
tuUM ill the rm.-tuH abtloiniuiain typhoid fever), uf the brain in its Hofleniiig, 
of thtf thyroid glund iu gelalinoas goitre. 



ItosiTAK^ET «ni3 Ymrnow have iuwd the rennela of ynnng girlft wrjr nroall and 
thin-wnllc*!. and wjrweiiiicut repfati-d ha^mnrrtiajjeB (koi- Cni.itlti>!4lr4). 

I'.XKKM tlvM\Toi » RhKOMtAHV n.t:.MuKUilAt;Ks. Bo-caJM. df'peml partly upon tlio 
giPAX »inttJ>:no« of tbo gTonulfltiou-veKeelJi, paztly upon extcadeU thrgraboais of tit- 
mrniuuiliti^ veitu> 

S(JuntMii>^>us cerebral ha-jTiorrhageji are aluiost alway* dependent U})an troe aueur* 
mas of the ocrvbral orfriiM, which aneuriflioii nm extremely small, to the size of n 



214 



CAUSES OP ll£UOE£UAOE. 



nia'B bead ond larger (CniliroT am] BoucnARD. Are^. dt ptiyiiii. nwrm. rf ftot 
1908), origiaating in cbrouic aticritis. (Zknkkti.) 

S. IXCnBASED PnEASims or THR BtX>OD WITHIK THE VK^KLS W COirei 
i^CESl'E ok active or TASSIVE IIVrEK.EMIA. P-*SS1VF. hlVUiOrr]ui^>S, %Ji, 

thofto tle|jcnilcnt upon co\(jkstiun, urc very fivqtu-nt ; Uiejr urise in foiisr 
fliiciice of iiicrcuseil littunil jufssure of tin* ltl<Knl wiiliiu tlie veiuK uin 
capillaries. 'Die iiiuat uiurkeil exHiuplu of tlij^ in foiiml in lliu ct.>up*ntiunB- 
iu tli»* regiou jiii|>|ili(!d bv Uiu luaaor turculHtiou from utfectiuus of tlie U-fi" 
auriyuKi-ventriculur opoiiiu^, or of iKo miti-al valve; Ll-ucv |Juliuonur,> 
lia'niori'Imgt'H arv vury freijueiH. Here lou l^lotig liiegH^tric hihJ iiilvstLtiiL 
iiieinoiTlmgfs in con true tiu as of tlju jutiti*! vein; the miuuu uf llttf tiew-lKirt 
from diuliirbiuicva lu tho piilmuiiurr and bepatic circulntiona, ( Vui9\>. ISO.' 




The mofit Hbrikin^ p.xainplu nf tbU fonn of hiBinnrrhag« U famiabed by ov 
cyBtu. whicb turn apon their axis and thereby slran^late their venelB; not oul;* di« 
cavirics of the cyste are flUed with blood, bub alno the o&vity of the periioneanvj 
contains blood. 

K[*]R(iEi.Tik.Ra {Moll. f. Geburtitk., IKdo. XXVI., p. 10) holds tbo omtual blooil- 
tumor of the new-bom to bt; u local manifeNtation of tbo cou^ittLoiL>> niiil cktrnm- 
(uitioDH in thi> cbild^a body, dvpendt'nt upon obtitniutionK to Uie iulonihu. ixn 

and (wiMiciaUy upon tJ»> premature iiiovpnient* of rrspiration. Thny bin ::ii 

on the cranial bon«'-8, brcauHC their fiii'loienubstance is loo«;ly coTerwi i ■ u 

and beuaoM the vesst^'la of tho latter cut«r the former almost withon ■••^\- 

and UinH are easily ruptured, 'by tbia io explained, bow that blood i:: nn 

also after relatively esxaj tiirtha. oa well or the idmnHt cnoMtanc llnidity ol the bluud, 
at the beat with smatl soft ooagula (for it ia Uood which ia effiutxl la threatened or 
actually present asphyxia). 



Active ba*njoiThng(»s occur iu uli grades in all forme nf active BVrwi- 
JKMiiLy must often ai^ luiaul bii>mnrrb;iges. Upon a stniibLr cHiise dcpentU 
also the fre<piBiit ImMnunbogoa of tbn brn.iii, tho ttevon* blucdinga at Uie 
nose, etc., in hypurtroplty of the luft voutriele. ( \'ide p. 18U.) 

Here belong also the "cohabitatioii-ba-morrha^tfit" descril>«d by WERNlcn ifitrL 
Heiii, Wvcfir,, l^jit, No, 0), wbiuh oocur duriutc coition, front the peculiarly ooa- 
Btruated vascular apiwratua of the uterine cervix. 

Also vii*AHiot;8 n.i'.MOi(itiiAOF..<t, especially from the n&sal niucoua mem- 
brane, more raiTly from nlci'i-H, etc., which Komotinicfl ivgubirly, RrmiMiiii«a 
iri-fgulurly ocour iu the abaonoe of meoatniatiou, ore clashed under Uiie 
hf^ad. 

Filially, from thiH [»iiM? m'lHc. moRt uf thtt lii^tnorrliagi'ii wliirb appHir iu 
the course of intlamuiation.s, as well thotio in conunou acute inHaniiuations 
a« nf all luuoouH meuibraiies, luiigB and nerve ceutrej^ us the hn^aiorrbo^ev 
in capillary aud large emboliMiiK (froiu end oca rtU lis), as well as cbioUy ia 
metuBtatio ulisd-astM: coi,LATEh.ii. ii.f.morbhau£s. 

4. CUAXOES in the WALI^ of the vessels AS» in the QbOOD AT TOR 

6AHE TIME : ILKUOKUHAGR' niATUEsis, i.e., n. condition in which, in tlie tuost 
iUiferent localities, htemonhageii oticur without increaaed vaacui&r excite- 
ment or BtagiiHtioii. 

The lift-'imnThagic diathcKis forow tho chief force in true scurvy, in di»- 
edbeH cliaraotvrijMxl by oxtrava&ationa of blood (/mrpurfj Mimplrr, j/^^utitis 
rhnimatieay vwrhtis mnruia^ut M'erUwjii), in the bleeding iiickne!Sft (bu'iuo- 
philia). It abo Mouititimes ocrurs in typlioid fever, small-pox, scarlet fever, 
meoitlus ; aeldoiu iu all tbe other ditteaauH with bigh tcmperaturea, which 



I 




OArSES OP nJCMOKRHAGE. 



SIS 



Uion Atv very dangivouH; in some contAgio-miasmatic diBcaRcs, as yBllovr 
fever, cholei'a^ the plague; iu Kepticiemia; iu the severo foriiiH of jauiiJioe, 
dej»eiidfnt or not on diHeHst; of the liver; iu acutti jioisouiiig bv [►lioKphorua 
Hiid the miuoral acids, duriu}( tlie extoiulod use of meretuj, in ulcohuliKiii ; 
iu utmiy ciueH of Uriglit^» di>>ca>f ; in niiuiy diiu^iuteH of tljc HpU^eu, eH|ieciiilly 
teuL-iicytLa.'mia ; sumetimeti iu ulilui-usui with luueuonbiea, oU;. 

The immodinto cause of hceTnorrhng^ in the haimorrluipo diathotis i> Htill nDlaiown, 
Exi»eritDeiits hy liK'^vAun. Sritu. Vincuow, O. Wkmcii, etc., on putrid uifecUtm of 
the blood, ^how that here true ohumieol ^ubittancc)) ore the caukb of tm:riiuiThajfv«; 
■ceoniiug to Wrueh, prolmbly milphuteUed hydru^n and sidphiiret uE ainmoida. 
PltCS3AK tSTRirKEn, \\'itiifffSi/j(j/if).. IHItT. LVI. > uhfien-ftd ail oliuiidaiit oxit of rt'd 
blood -cnqitiKolM tliroiii^h tlio miinjiirod oniiilhirj-wrill in frti|^. pertintiftiiimi in mliliit^t, 
into which be boil injected u lar^f i)uiu)tity of a solutiuii of common suit. TbiR wns 
the first certain demonatmtioii at the irnlci'cndciw;*? «f Ruch hnjnoorrhngeBfroin bliKwI- 
{irctwun), but through blond -chiuipjH of a chemiciLi cliumctvr (or of the TUHU.'1-wnU ?). 
CouxUElM (/'('■ emlfA. /Vor., 1873, p. 3d> eould u<it verify theite experiments. Sec 
■vreiml cues reported by the author iArck, d. Heilk., 1809, X, p. 3ST> (See «1m> 
the BChOftUed ncdte fatty -dcKCuuratiuu.) 

A hcumorrhiijcio diathef*ii« nuiy have its oriK'in in b Ion;; uaq of the mlnontl acids. The 
eff«:ct of iudini: iu hook; individualn is peculiar, in that it givus riiK soutetiinus U.t 
exanlhenuta, sonictiiniiM to luLinorrhag%fi. 

In B cftKo of pitrjfttra m'm}iii\r, (iutEHiNUKK fonnd in placet where tigfatJy bound 
gBTtere had exerciaed a prcMnirc, almost no jiurpnra spotA, and foanded thereon a 
tban^ieuais conaiitting in bandaging, etc {Arefi. d. UeSk., iV., p. 383). 

H^EMORKrfAGEs on* uot iufriHiuently DEPENltEST ri»ON THE siwri.TAyEora 

AtTlOy OF TWO OR 310UE OF TltK (.Al'SKS SAUEI*. TliUM, e.//., UroilchlA] 
lis^mniTlMgrMt from chants iu the rn!^M;l-n'nil and froui dilotutiou of the 
vessels actively or jiuanively (coufj^ontiuns from tuburculur depo^itb, etc.). 

Many orgaiui exhibit a sti-ongtn- i-Kizi^it^rubiTioN to nxMonunAORs Uiaii 
otherK, bHciin»i4 of the |diuliitit v <>f the Hurroitudiiig ]>Art8 ; (T.j^., many purtu 
of the snt>cututieona ceilnlar ttRsue, of th(* Kubuiucous tissue. The same in 
true of the braiu, luugR, spleen, iu which cirgnnn every intense iulliuu- 
maLion "is followed by vcrv numcmtis exti-avasationB ; red sol'teniug of tho 
bmin, red hL<patL74ition of the lungH, owe color and uauio to this jiredisjiOMi- 
tiou. Other purLs frequi'ully become the fleat of hiemorrhagos, oiil}' be- 
cause they »tre more exposed to injurioiw inftuonees, as the nasal uiucousi 
lueuibmije (in<fchaiiical iutluences, more fre'iuently chnn<;es iu atinoiipheL-ic 
teiuj^erature), thai of the rectum (mecbanioal itdlueucc«)^ thai of Uiu oon- 
juuctiva, etc. 

Bhteo the causes mentioned l>elong uneqoally to rorions ages, the old opinion can 
tightly be maintained, that the head in children, tbe thomx in youth, the alMlomen in 
later age, most broquenUy funuah the causes tor hemorrhages. 

The AN'ATOHfUAL (.'HAS0E8 IS TOK BLEEDING VESSELS THEMSELVES, AS 
IVELL AS OF THE TISSUBS AKD ORGANS AT THE SEAT OP ILiEMnUllUARE, 

diflV^r, osjfccially with the character of the bleeding voRSek, with the aizo 
of the kd'morrhage, with tiio time siuce which it occunvd, and witli tJio 
kind of tissue and orgnu which is the seat of the hn'ntorrliafic. 

Tliat which tirst of all concerus the DLEEniso vessei«s themselves is that. 

THE GBEATKH .NL'MUEH. OP U.EMORItHAOES (EASE OP TUBM^ELVEK. The chief 

causes of this si-osTAKEors itLoon-AnnEST ore, fii-at of all, roAut'LATios op 
THE UUKJD, whieli uppeara as aoou as the blood leiives the veswds. Tlie 
iiiHueuce uf the coiniooLtve tissue, e8|K{cially of young uew-formatious; the 
preatAce of furtugn IxKlieti, among which blood-coaguLa also belongs ; the 



210 



AHKKST or IIJSMORItllAOK. 



tictioii of ccftAin seci-fltioiiff (syunviaj bHlivti), and of [m«, hastoiis crtfiguU 
lion. lif-siilnn, the srnNTANianjs HtrTHACTioN and r<iST»AtTios np tji 
VEKHEi.s, which aiipoors in tbo duinllor ort^^rioa rieh ia mti^icnlai- tisstti 
luii^luilintit itud tniusverse, and is a conseqiieuce jmrttj of the iviuoral o 
leusioii, pui'll^' of the t.)-aiitnnttc iiTitatinii ; the nsitttiiiig tine phiiting of tb» 
iunur surftux* iiieivtiii(>H lU<.* (loiulH bf dt'posit for hIo<Hi-cuaguIatiuii. Thv^ 
BL'i{Bar»D]?io TlssLKS, at first hj their serous or celluhir iitfiUrution, Utc « 
by their conli-acliou, cause closure of the blooding viwRtrls, and tinu amz. 
arrest of the blood, e»inoutlly if iIil'.V, lilci; thu itkiii, scrotal buc, Uibio, nui 
UUP, uteni8, lUr rich in ooiitnictile tisMie, eHjiL-ciully in orgtuiic uiu^'1l>h 
while rigid tissuvs, likf spongy bones, tightly strotclifd fiWL'ite, (*t*.'., fuv 
the contiiiimtinii of hwimtrrhiij^o. Tlio bKritBASE of BLoop-i'iiEiifiUKE : 
giiait Ii>s.sfK of hKxid iiirrtiuM-s tht^ abHorpliou, riiuscK n iiuii'kfr Intliix 
lympli through the tlioracic duct, uinl tbcri'hy a iiv.in? abiindHiit ct 
truncd of colorless blood-curpnficles into tht- blood, aud OMsist^ als" in inrn' 
iug thn cimgiiliibiliLy of the blooil, Kinully, ri'pi'atud h.t'iiiorrhiigi'H ht'igbte 
the couguliibility oftlu* Itloixl; in tii('iiiorrhug<e« tJio Inst [luitions of bliH>r/ 
cuug\ihite aluiost iiistiintum^Uidy after tJm lluw. 

*IMK rlRt rMSTAS'ES IlIKVEST OH RKNt>eil hlKFriTI.T THE STOITIKU Of 

Tnx bukidV flow. Tl)U8 loiigitudinul wotmds aikI in<-on)p[t*t« tnitLsvcrsi* 
wounds of the vchscIs, becauHi* thn contraction of ihc muscles only dilate* 
the wounds, nnd retractiou of th>) vcsaul i^ roudei-od impossible. llicm(» 
I'hagcs in [>urt« whiuli are dependent cca^ with greater difiieulty timu iu 
thosit otherwise tdlualeN.! (ha'tiiurrhaj^eR of thu lei^, reotuui) ; strong uiu- 
cuUr moveuicnta pixiuioto bUxedin:* (known meaitn of aaKiHtHUct* in veuHMco- 
tion). [n like inaitnm* preasniv act^i upon one or more of the veins l>f1o4^ 
in^ to the siune vaacniar ro^on; alao violent expirntory nctn, es|w*i'inlly iu 
crying, eou^hiti>^, Hhef/ing, i^ikowiflo warmth eKcrtis an iutluenco, iu that 
it ii;liixi*R the vcssehi. 

The FisAi. iLosLitE i>F nLFiKDiNn VEssEi-s followB upoD the foiiuation of a 
conj^uhim, which fills tho wounded vessel as far ns tho neaies-t rojtnterht 
bntuch, and which, within a few weeks, grows pair, beconies tinner, and is 
iiitiumti'ly altachril to the vei^'fel-wul! : it tiin:.\NiZE8. This tnkes plan) in 
Lhn sumir way ns in ttii*i)ni)K>Hiii of another kind (see p. It.' I). (!!!uiinecLive 
tiMnie-tibre-s aiul vtTSAels are foiiiied, whicli lirst n|ii>ear iu cumuiuuicatioD 
with the vessd'a ivull, later with the chunuct of the wnunthvl v.'s.-^'-l. 



i 



i 



The MANNLIl OF ll!.\l,l>U op lU.EEniM* |-aU1;s OK THF. CIWIir.A I mU^ ^^^II-.M it 
of hiyh thoortticivl. and c>*|>et-'iall_v of practiwd iiiwroflt. H.-KMoHan ^'t^.8 yn<nx tob 
tlKAHT. r.KKAT AKTICKIES aiiil prc-at vuiiiH uTo inoHtly foUowwfl by v«ry ijiiiek dt-alh : 
in vorr ri»re cmst^ a imrnuuiwnt euro takei' plao« after muall rupture* of tbe ht-urt in 
adlieivive poricarilttiH. ami in liurenitmn nf tbe iutemal luid nudJlu uuAts of lUe aartm^ 
will) ofTuHJon of \}\oo\ undt^r tho aitvtriittUii. Httiiiin^ nf the WoiiKOK oP Tin: kk> 
SlAiSrSG AnTEUlKSili(f'>rs«'itlithe»iiieorthfnTti-ry. Amlmih fiizeaniU'huniDti-rof tbo 
wound. After eoiu])U.'te wctjoii or laceration of Kmall or medium - ' 'ii a 

haaltJiyrttnte, the middle eoiit whii-li in firmly winutrMsl with the if ^'ly 

contrnetB tmufiTersely. and recwk's witliiti lb*.' extt-rmU enut, with u,,. -,'Iy 

connected ; a thrombnn fornis lielweeii the jwinl of Mu-fmiiCR and tlor i' ■ i.-b 

above iir bulow. which tbroiuliiitt adbercs to the vewel-wnll. and in the i i me 

contiuuea to nhrink. Completely vevered arturieii of Inr^fC hIko likewiso oiiiiiiai.-!.. but 
for the moflt part not so comidi;t*Tly that the huimcirrhuire Is /oTe!*t<vl ; flii" Impjfrns 
nometiraw, at leant ti-mpnrnrilj^. from a weakn**iw of thn Imart's* c-^a ii;li 

lo«a of blood, aiul cv(tn faintiu"*!* WoiiniU of artsries whii-h do n-n . >Je 

elrciiiiiEereiice, dift'er in tluor etleot^ with the Mtv oi woundi*. irig 

woutidt riioBtljr jfive rise to ^^maIl throiilbusis at the point nf injur. tlie 

tiaiuo immediately surrouaJiug it, and tbor«hy healing. Largi; «■ . '- .^i 

only a part of tho ve«M)l, caune a strong tJ-ausvene and lootptadiiuil coutmctioa of 




AIU{i:8T OF H.^[OnEUlAOE. 



217 



Ills. ^RpeciiUly of Uie middle coat, which culnr^rc^ tho wound. tta<i whEoh finally 

mn boul aiil,v thrimi^li tlie fonuatiou of a throtnbomii of the mi rroti tilling tinxnf!, aud 

I at the nrlfry itj^t-lf tut far an the iiPit rnllati-nil hmiirh. H,K»liinuilA(iKH fUuM 

■iui-i< VKi.\8. AM) fKiiM TUOFiL OP MKDFrM M7.F. imii.ill.T cea-^f; tLruu^'li < ullniwe of 

rwi contrul luiJ |>nrii)hi-ral extrcraitits of the veius. iifter cou^niUtimi ut tlio l-l.>o4l us 

far u Lbo nmn^Ht viUvk. or the oenrent oillafcml hniiich. mid lUnmtrh Om n'Ih«"'inn nf 

the veuotiR wnHK ; iirt"^tm> of Uk' Mirroiinilioi; imrtit tiKisiDU in the urn'^t, exo-pt whun 

the latuir nrc ioflcxitilc or in<lariitt-N:l. n.fCMnKiuiAr.KH kkum tiik rAi*li.i..MtiK8 aro 

contr^illi-il partlr throoph tx-ogiilation of the blood, partly by presanrc through cou- 

rjnction nf the Hurrouudiiiu partn. 

PBConmilt nlso BlKstADECKl (TngM. d, Knturf.- Ver*,, 1978. p. 3!7i. 
** Tbts hcaliug of wounJit of veoiu'la u) of ef^ecial surreal interest in t.TfiATntR 
OF TBSSELS. At the POINT ov l.tOATmE tbare vueunt a wipimriitive diH»<olutinn or 
nvcraiu of the nilrcntitia (the iott'ruiU and middk^ coat« axv out thr<Mij;h by the 
ligat-are and retmco. and RTcutnally n Hiniultiini>i>iix solution of the iiirroimdiiig 
\imufr9: then the ligHturc fnlU off. This takuti pincc. according' to the aisc uf th« 
TttsoeL, in from ihwe in t-wejity si)c dayn. It oi>enni too early, if Iwfori! the tJirnirhnB 
has bMcotnc oTpinix>Kl mid nhrinkH. hA ui di>i(tai<r<l airteri«H. or if snppumtioM t^vtm 
anpean to the tbromhai, orif the thrcxnbtists too Bhort(if biyu bnuioht:5arQf,'iv<ju 
off Immodintely above the point at which the ligature triu applied) ; thus frivinff rite 

tOSO-Oallftd BKCDHDARV II.KMOUmiAr.K. 

Kl.Klu« dekctihus na oejitic, or tertiary hirmorrbogcs t-boM dcpcndrot ou the pcnotra- 
llon of hi* mifmn^Mnm into the arteri<^s or Teinw. ( Vitfe W.v.ytJA. ) 

Tht! faLe of thn li^tnre nftcr ligation of thn nrt>rripn in thmr txintmiiity is eMeu* 
tiolly the name a« aft«r li^ttion of their divided extremity, us in Aitipututious; 
evcnpt that a cooj^nilutii iii formed an tar an tbo nukicut coUatcml branch abovu oud 
tmlow tb<.- Ii>;aturu. IminL-diaitly tltcrcafler the vctiHfltt above and bolntv ihc ligatul 
art»-'ry dilute and intro hicc the roi.i.ATKK.\l. c litre t at 10s. Thi« is fi-Hort-ed. always 
in the nuall arterien, almort almyn in those uf mf^liam nize, and often eren in tho«ie 
of large wxe tcorolid, rrural. Biibi:Ia%-ian}, by n smificiMit wipply of hlood to the part 
Iwyond; the temperature of the purt rcmftina iiormul, or is lowered for a few houra 
only ; all the functiouit remain uualfccted. Proportionately nirc are divtnrbanceB 
arisinir fmm; iHChirmin. when the i-oIlatt!ral clrrnUation i* only incompU-tcly formed ; 
M>metimt.-B rcooua cougi^ntionK, in lumHfijiu-nL-t' of lufwencil tm ii Ifrijit; HometirnBa 
collateml h^i-jienemitu, when the collateral circulation bos been (sstnblishwl too quickly 
and loo fr-'f ly, 

Tlu: tapi'iity of the formation of the (wUatcral circnlaUou after ligation of arterte* 
in UiL-ti L-imtiuuily, is HbuwD by the fulluwing rasaltA from cxperimcnta modu in a 
la^e tlHHhy di>ff liy O. AVbbkk: 

Blood-preanre of cmral in free ctrculntton. (19-75 mm. 

I " " " after ligatioii at central end 72-^'! " 

^H *' ** *• '* " l)eriph.Gmlimmcdiotclj.at>-3a '* 

^B Oiie-haUhourbter...to4-l " 

Reoent n.cuoRKTiAOEs INTO T188UE8 bfliftve in atxwrtluice with tlie size 
^£tlie linMiiorrhagi'. tht; kiml uf tigsiie invulved, utc 

^■tf thv H.EMouuiiAORs AHK VKKY SMALL, iniiuerous red an<l i>ti>lHtf{l wbitc 
^|6od-cor|>u soles, ulono or at tlic samo timo vitli tibtin iu inoleculiu* or 
reticiiUtetl form, ara fntiiid iu tliu UsHiies eitlit^r witltiii tlio DHtiiml 8i>ac«a 
of the conncetive-tissiK", esjieciHlly (ilso in llio radicles of the lyiii[ihatic8, or 
between the se{>aratod elwmonta uf tlio tissue (epithelial cells, gland-celts, 
connective-tiftsufi bundles). In thoKe ca^-ti the hlocid-corjin&cles, nt lHa.«jt the 
red, nmy jjcnutratH into thei intericn- of cellK, whwneH the rKM.R co.vtaixixo 
BLot>K)-i-'uia't'S(rLRfi iiria', as well fntin the contjiictile cells of connective 
tissue, etc., oa from npitln^lial (oral eiinty, crsnphagns, bhidiler, intestines, 
iiingK), from glambilar cells (Hploen, liver), fiv)m cellnhir ni^w-frniiiations 
(rarcinniim). It is hardly possibly to dniw tlm lino betwr^n uoniud and 
[mthologicid n-'lls contiiiniiig hloo<l cnrpuHeh!.s : iu the nplwn. bunf-inarrow, 
ejiendyina of the cerebral vuntricleu, their occurix>Dco ia as frequent as their 
abttcnoT. 

The author {Atvh. d. ffritk., 1868, IX., p. 407; 1869, X, p. 337| has accorately 



SIS 



BPEOIAL n£K0RRIIA0B8. 



described tamaj forms of suvli umall, epiibeliol hoanorrluigce in muL 
ollA|itar on pigmeiit-moLimorpbtMiH. 



Bm alao the 



When the ii.f:MORRUAUK» aue LAiiueit and affect sofl tisaucSf the elemeaU 
of tbR latter hit- tbcu ofteu bei-aiiated prom om: asotheu : a. haMiiurrbngv 
uutlci- Uie Biirffio«j es(>fci;ill^' ot'eiitifiilar orgiuis, is calltnl liierimtoiuu or blooid- 
boil; <iue iiiti> the interior, eft{M!ciitlly of |mr(;iichyiiuitoua orgHns, mtht^ 
siinitle hu.nut>rrhaj^? (an iiitu the intcruiciliiitu splice of turu muscles, brok^u 
banes) or htenionhngic iDfiirctiou. Or the tissues, eapcci&lly in arteml 
hitiiiurrhugt*8, aitJ tohn : ha-tnorrhu^c focus, clot. 

ILbmatoma, BLOOD-TrMoii ur BUiOD-BOiL, furritB n tuuiDr-b}iupe()| some* 
times more glolml&r, souietimuH fluttcn* accumulation of extravftHatml Huict or 
coagulated bluod, and of various sizes, wliich ariJies fi-om (HtlV-retit csiues 
(couge»tiotm, etc.), aiiil uiusst ofteu ouciipiea Uiu tmrikce of ext«-'tided organs. 
llvrv Ijeloug : the blood-vesicles of tbo skiu, which ftrise on the titig»»r» from 
bruigiii^j!, tuid He iu the so-calleil stratum hicidniu; ximilur bti-tiiorrhii}^4 
there, or in th'! stratified epilheliuiii of thi? mucous membranes in inorhtu 
vtacuio^wfy etc. ; besides, the so-called blood-boils in the subcutaneous cou- 
nectivf tissue, bu^umtoma of the vulva iji the iis«ne8 of the lubia, polypoid 
liaMuaroma of the nterita at the [>oiut of insertion of the placenta, oephalo 
hoematoina between tlie cranial bones and pericranium, othiumuUima btrtweea 
the aui-al caritlagf-s luid ]>erichondr)uni, hematoma of the dum mator W'twcvu 
the newly-furmed layers on it^ iimrr surface. To hiematomata belong also 
the false or traunuitic am^urisuis : haiuiatomata are distinguished an difltiMv 
and aa cncajmulcd ur circuuiKcribeJ. 

The oriipa of OTiiJiMAroiu. is e«^7 explained, according to L. Ukyeh (JfM. 
GtrUA.. IHi>}. No. .>'>). Ii; the faot that the reticular oanUiiffe of the ear. iu all agtw, 
alwnyif ountninii veaK«]^. Ot.bers, rii|)«oia]lT Griirmx ( Virch. Arch. , LI., p. 4oT), diiv- 
putc thifs. Pi.tiHii<Mi>1.Es, so-cniicd. nrino frum numerous c(Fu!*ioiu>> of tilood lato the 
ti«8ue (if tlie plaoenta. U.f:>iAToUATA or tiik i'lacenta all pruueed, acconlbig- to 
OlKlUE aud U SLei'KEL. froiD blood-coatfiiJa. The youi4retsl b^eiiiatDuialH apficar to 
ariM ouly in tW ateriiiu pDrtions of the plnucut^k Auuordmg t4i Kl£U& Uie t^tfusiaa 
of blood at firat takes placo ouly in Lht9 Ij'niph-KjMicus of tbo pbioouta. 

U.EMojtim.vurc ikfarvtioss form a roundtid or wot[;;e-«hai»eJ, not tumor- 
Bhu{>ed, centiul or (keripUei'al, circumscribed, dark or bluek red, deuse niasaeB 
of etlii.s^'il blond, which are of diH'Hrent sizes, and on section pifSHnl ii iitd- 
fonn or granular ap|K;iirance. Under tiie niieroscope blood-eor|uiscle8 uud 
fibrin lux- found, not only in the normal mvities of the organ (alveoli of tJm 
luiigK, urinury canal, etc.), but also between the tbu(ue-<^leinentH ; the hittvr 
are usually not at all torn or only iiartly so, for the moat part racrwly aejp- 
ai-ated from one another. (See also p. 217.) 

JI.GJioRnuAGiu poc'i show a poi-tion of varying size of a tissue or 
organ, ofteneat the brain, torn and blood effused into the rent ; the blood 
is seldom tluid, mostly csoagiilate^J antl periphcrically containing fmgmeuU of 
tiflHue. In rare caiiea Hie tibi*in eougtdateit in the |>eriphery, and foniiB a 
kind of cu}i.sul6 oruuud the ivniaining part of the extra variation. 

These all (ha-morrhagic infiirction, etc.) mei*gi' into one another. 

The TISSUES IN THK V]eixiTii' of rewmt litt*iuorrliajre8 are sehlom normal, 
luoatly ruihlish ur yellowish through iliFfusiirn of the coloring matter of tlifl 
blood, or through filling of the lymphatics with blood, or through true 
hypenemia; fret^ucutly they are also anleniatous. The surrottmling tissues 
are even compresseil in greater extravaaatioua, aa in closed cavitiua, some- 
times iu greater extvusiou. 




OnJlNOES IN EFFtJSKD BLOOD. 



219 



Xq a]l thette caiiofl the tiiru veAtwl ilttblf in almost iiev(>r found. It is uio&t 
frequfiitlj* found when vesselH of luediuiu wize, tir ntu-in isms of muall vease]** 
buTHt, iu ivpilltu-y ct^rebrul ]iiuiiiorrba;^<!% whcu tin.* itmul) white points in 
the rviilro of the «xtr»vasntiuii are the t»rn {iirturiul) vc«hc1&. 

WTit'u II n^cMORBiiAOF; into a tissl-e hus taken pluct', in orgatm nch iu 
Ivuipdutic vc^HtdH, a |iurt of tlu> hhioil, which iit the time of tliu ha'inoiThuge 
waii forced into lh..-)X* veascls, in diiven btill farthtT on — u (nocjaa which in 
the luiJ^ and kivlncys it is vaxy t-u obsi.'i'v<^. lu very sinutl hainiinrhiiges, 
OS in those pfir Uinjifdeahij etc., alt the exti-avanated lilix)d-c<ir|iuscles iiiay 
in this manupr be ivmoved. lu the roiuainijig caHtiS, however, tUl or nearly 
all the blood reuoios, and here becomes farther changed. 

OnrR( Vireh. Are^, ISIt, LTL, p. 309) foutid in a oam of tranmMttc hicmor- 
rbngv of t>ke lower extrotuity an ingtiiiial ^land of tbo sixe of a plum, dark red. tixed ; 
itfl lTTnith-vr.*M«elfi werr^ tillnd witli blrK^d-corpuKlcii, ab well as tbo gUmduiav p&reu- 
chjuiaf the lympb-corpuaoles ot which were entirely wanting. 




The ciuxQCt wutc:u kxtravas.ited blood csdebooes are: moat fro- 
qacntly KEiSfiRf^iON, at firnt of the Mrrnru, then of the remaining couttLitu- 
enlK. 'J1if> liitter are wddoin .tliKorb«*d h<-fun^ thc> n]i|>oiHritne(f of cua^ulution, 
as in ceptialn-niiitotna of the new>U>rn^ (.'tc. Resor|ttion apiivant niutiily i>uly 
aitur ooa^nlotioo. This becomea po&i>ible by wimple solution of tliu fibrin 
and tran»furnmtioa of the wbit« blood-eorpuscleH into albuminous and fatty 
detritus. To thin perhupH also is uddtnl a Hi.'i'uns exudation fi*um tlie sur- 
rounding veKKtds. Reaorplion of tlie red blooil-eorpuaclcs, according to 
K>iut% i^ acconipUslied hy thiir cntmncc tn tola into the interior of anrround- 
c^lls, and there undergoing further change; uecurdiug to othent, on thn 
er hand, by the tmnRfonuaiion of their pigin<!nt at the place of extrava- 
on intti granular or cry«talli«o ba'umtoidin (vuie Pigniontary Metonior- 
lia). In most of the larger hscmorrhageB with monr or leas laoeratioQ 
of the tist>UGS, a complete I'estitiuion of the latter never takes place. 

A l)i(YiNU-L'l' and tiiiftl wearing ulf'of the bloody ctfusion uccins in small 
hjrnmtomntjL, whicli occupy tlie epiihetial Inyeni of tim Hkin (hlood-bliHtent) 
or mucous nienibranea provided with laniiiiutcd epithelium (asophagus, 
blatldt^r). 

A L'UER8Y METAMOKPnoms of the blood-cvm^iilum oeciiis sometimes in tha 
int4*rtnr of normal tissues, f*8j>«'viiilly of the lungs and spleen, as well as 
within large va»cular uuw-furmations (miuiy cancors, especially of tho 
kidnoys^. 

Mure mrely there occurs CAtjciricATiON, as well as AHYLOID dbobkeiiation 
of the coagulum. 

Only rarf'Iy it sorxENS, sometimes with consecutive snppuMtion. This 
happenH in large o)ioji wounds of the sui-fac<;, also (after considei-able 
bruises) in the inti*rior especiftliy of the extn*mities, rarely in the cavities 
of the joints, iu mucous membranes, anil lung-l issues, 

Mnny nucm of so-oallerl brown noftvning of the cusnphagiiR and Btnnianfa are depend- 
ent ' -'lorrhagic infarction with con«ocutJve Holution t)y the contt'iits of th« 
tt. rnoK. Arc/i. d. UrM., 1807, VUI., p. 404. UOKKMASN, VtrcA. ArcA. 
Itj6>>, .\Li^., p. ',ii}'2i. 

Bometimeis the elTusitd IiIo<kJ liei:;iinms ri'TRiD In oonsequenee of the ooo- 

. of air, in hB>morrliagos of the surface of the body and of the lungs, or 

om contict with tbo auui'etions (urine, faeces). Similar changes may then 



S30 



OnAJfOER TW CI.OT ASH TTBSrKB, 



extotui to the siinxiunding tissues and become the causes of gfmgrene or of 
scpticiL>mia. ^ 

Sliuiiid lift* conliniie for wc*^ks and longer aft«r (he ooctnreiice uf «xtn- H 
va&itiou, still furtlier transfuruiatioiis appear iu the latt«>r iuelf, aud iu thi; ^ 
tissues iiiiiiiodiattil)- udjacenl to it. TKcfto chiitigt^ outmint iii tlie ohcakiza- 
Tios of thu t'lTust!!! blood, and iu an an;ilng«u8 tissue foriuatlun in the sur- 
rounding parts. Eicamples of this are fiunialied by tiBsnca of atiDi^t «n«ry 
kind, t'-ujii-ciiilly tho subcutaneous cellular tisnuc, muscloii, bouf^s, )uiig% bruin. 
OrguuLZtitiou of till' wliulii tniisa of t'fr<i»i<.'d blood is comparatively ran*, and 
has bet'n riKi'iguijiod uiUi «*i*tuinty in only a ft-w p!u4.*e8: in (♦'iiotouiy, Id 
cutK and bi-uiw!S of the luuaclefi, in tibroutt puly[>i of tho utoruH, iu niMiy 
oorebral htenu)rrbag*'s connective tisaiiu tluta has iis origin, whih; in fracCiiro 
of bones, in cephiiltvniatoma, elc, okhi*oii.i tisKue iit form>-d. ^Much more fn- 
qucntly thr pi-ripliery only of the effust-d IdouJ is orj^aniztilf while it« t-yintrml 
portion li'pn-lifs imd is wholly or partially iibwirht^d: apnplr*etic cy«8 and 
indurntious. Xot iiifivipiciitly tho tiswuts in imniediaty i.'onUict with tho 
extravu3«tiun in part maintain their int*'grily and become in jwri absorl«d, 
BO that generally a riijfularly rounded sjmcc is fornii'd, the inner siirfnoe nf 
wliich iK'ConiL^, through ^lo orgaitij£atii:in above-niciitioiiod, aiuooih and 
dentin: so-called Aropi.E»:Tic c-vst. Tliis is filleii at first with a pnlLaOLijiu 
nuLSs, lat^T with 8«iruni. Its internitl surface is ofreu of a yellow color fruBo 
pigment- change, red or bluckiAh, but Hlwaya withotit epirhulial liniait 
Cysta of this kind aluiostt alwaya continue to exist. Aroi'LKOTur cii^atkicxs 
bavo for the most part an iminediutv origin, riirely aft«'r jirevtons fonnatifai 
of cysts. Thcjje ciealrices ri'present an irregularly shuped ti^un*, wb<Me 
walls are indnnitird mid un; in iuitnudiate contact with oiw another, or an) 
UHparatHtl by jfiginent. 

The nusoEs whkh .appear in tissues surrol'NDIno ou> uxHOKHnxttw ' 
coLMurriOA'S ore, besides the pigiuentKtiun, eouiieclivu titf»ue or oeuieous new- 
rorniationK, and the aun^mia and hypenemia uli-eaily inentiontHl: intlMinma- 
Lion, suppuration (absda fiematiques), gangi-one, ati-ophy of etiSciitiaL tiMtut)- 
elements. 

LLcMOtttiaANES INTO PRE-EXIBTINO CAVITIES AXD OAVAIJI behavo in » quJt* ' 
aimple manner. 

Iu h»morrhagt!S intn skikius cavitiks the bloml is not rarely entirely 
absorbed: thus in traumatic ba'matothorax, ha>matocelo. Otberwi&c the 
above-mentioned nietamorphoHi.'s aet in, eHpcelally pigmentary meiATuorphrw 
sis nf the c»r|iuselefl, ami drviiig or softening nf the fibrin. Larger hiifmnt- 
rhages aro Bomeiinica ftdlowed by suppumtivc intlamnmtiou. The blood 
freely etTused into the |Totvic cavity iu peri- or retro-ul«rine hiemototvlo is 
renbs(trbctl, or eiiCHpRulwd through a i*ejiet.ive peritonitii^, or it snppunit«'tL 

'I'liu bliiod cflTusixl upon Hircors mruiiranes does not long ri-mnLn where 
extravaHiited, bub is removed in vmirms ways. The mucous nieuibnma 
it&elf often shows no chiinges wnrthy of uotieti. Hei-e it in to l>w observed 
that the point at wlijeh, in the dend iK^ly, tlie blnitd is found dof*a not 
HlwayH o<M're8)Hind with the prnper Keat i>f the liiFninrrhage : in gmtric 
hfcniorrhagcs the Htonintrh is somctimc>8 ero]>ty, while the small and lari^c 
int^fstines contain bl(ir>d in large rpiantity; in hieinorrhugt's from onr Inns 
bhiud ia not infit-ipieutly found in the brtmchi imd alveoli i>f this, ns wrll 
EH in thoKO of the other lung, or blood in the Btonineh, ete. Unt if the 
blood i» not removed, it suffers the same chnngeft, as in parenchynia^ mid 
serous cavities. Especially iinp(.ii*tj»ut in this connection are the htemor- 
rbages from the bronchi and bioDcbiectaaea in other normal bronchi mud 
•Iveoli of tho same lobe or of that of tlie other lung: the removal of the 




STxrroud of h^emoruiiacc. 



S31 



lood bfing prevented hy various circiimslQuceR, tlic blood Iicrc di-ies Hp 
n<i deprives thu parla of uir, but jcpves rise hIku to now cutni't'tu mid intll- 
rations; or it piilroti»«t, hs hi ulrtTOiis Ijnuicliieotjwis, aiul may tLua bo 



iloc 

a.n<j 

tratinns; _ , , _ 

followod by gougrciio of tlio surroutiiliti^ tiiutuu. 



Prrt. anil LtPMANN ( IVz-M, Ar/A., hi, p. .W9| fuuud in ortificiiil pQ]inoDai7 

•tuorrha^i's of rabbita und iic<gr>, ttuit the blood eflu5«d tu a brtmcbiiU biuinorrtitt^u 

•«ef] iiiT4) the fiiKtt bruuolii auil uitt> tho alvooli. tliat ufUir I2 boiirt* cooipila nrt! uo 
lunffcr (iciuDustrntilc in tbiti lar>;vr brunchi. tbat tbu UUmkI RtTiiHRcl int^t the prt-viounly 
•ODud fiir-piVMigett docji not net an exi'itimU of iiifliiinmntiun, but in ^oilnuUy tty- 
■urbui! wilbout lenritig l>ehitul any lung-rhiuigtut nibcr tbaii mo'lorate oinplijHCtna. 

:>OJiwtumi'.»r>T (.WW/. CtHbi., 1871, No. -I.lj iiijoctcd the air iwiMagcit of docs 
with bluo-l and a solution of tho w^'juiohloridc of iron mid killed Ihein from 1-13 
liour>* t.!* V'-Pw days tliereiifter. 'Hie blood wbicli reacbvtl thu oltuuU iiidru-cil con- 
stant ratorrhal |mc!iiniimL-k. Aft^r A-*\, but t'B[n?cinlly iift-er 34 houre. tJie cbanwter- 

ir. lar^ cr1I» (Ct))'URHrt) appenr with the blnod-c^llA. and ore on tbo 4-<1 dti^y jirvS' 
Dt in L>uiinnoiiAqn(U)t4tle8. The oellri have their oriifin in the epitbrlla uf tliu uIto- 
oli : tbc^c uiorfabc tn n\?.<i. liccoinu turbid, luid aru disltiit^uiHbvd b>- Ioaviu)t liuhiod of 
open iifinctr* in Lilt! v|iithv]L-kl aurfitce. The gruat i-cUm liike up into l1ivmi4t-Wi.'H p?d 
b|no<l-ci-!bi, Bi)ni*-limL-.a :i to '). On thr 1 Ith and 12th day th)i gxrat cells aro colored 
bmwn. nii'I <'qnal thi>?f ol>h(*rvcd in afffutions of th«? htnrt, 

'I'hi- hlixnl wbicli hii3 pu><.svd from Ltronuliiect&v^ or otticr forms of cavema into 
otb'f parts of the lung. 1 found in a few oases qait« wftoting in librin. 

Tlitkt blooil. wrhioh ia freely effuaod Into cavities aud remaiua tor a longer Hme, 
Anally orgauiAO*. has long' b«en maintained with r(«]KM;t U^ thii blfiody or librinoiw 
|K>)y]ii l{H)ly[:Htid lispnialDmai of the uLerna. Thin [lolypnjt \* always a product of 
prepuLncT. Kither the retained membnmcii of an abortive or retamed plnccnta tn\- 
nifih tho stem on to which the blood-miuis jitill farther colleti^ and coat^iilat*:^. or they 
arijtc nftcr (yjiojiletc neioniltou uf the after birth, tbroui;h tippu^^ittiti cf LIil- ribtinoun 
c<Ki;;ii1a to the prolruiliii}: (liroiulii of thv purl mIutc the platwnta Mti» ii])H;rt<;d, whieb 
latt«r HomrtimeA, during an otbi^rwiHe tol<tral>lt^ in\-ohition of th« atvmn, pmlnidtHl tin 
a round turaorinto the at-erina cavi^. (Kiwiscu, &CAMZONI, VlBCllow, Rf»KlTAK- 
•KT, KlX^B. FUA.SKEL. ) 

HfcmniThagM into the larger ni,A»D-DUCT8 act in geneToI like tlioae on 
mucous u«'Uii>nturs; tliosL* iuto tin* KiuiilltT, f*.)/., sweat-gin tidfl, distend 
tbeiQ aud cause saiull tumom aimilar to hmmAtuuiata. 

SYXFTOUS ANT) COKSEQtnCfCES OF ILCHORRHAOES. 

The syniptomfi of liiL'iuorrliage depend jmrtly upon tho kind of IttDinor- 
rlis^N pnrtly ou it« size, partly ou its locution, partly on tho chwigus 
wirKifi the extruvnsntiou. 

KxTEHNAL II.C1IOHKUAUE8 OTe easily recognized. In wounds of external 
partJi (uftlie lH»ly anil of the e:ilreinitii>«) the blood flows, with the excep- 
tion of r»iu QIAOS {aitrurhma ifpnrinm and a.rnrico»u/>i) immcdiatoly to the 
surfiic<*. From the mticotis meiubranen, out of the ib^lancls and dttcta, the 
blcxhl. wholly or iii part. Hows imuicilialt'ly to tin.* exterior, e.f/., from the 
noice, mouth, vagitia, umthra. C>r, tho nlUiscd blood itself by irtitation in- 
ducer net** which n-niovi' the blood : bloody exjioctoration, bloody vomiting, 
blofMly uriiiaiiori, biuody utorint; How, bhmdy atoolti. 

'Hie blood of hieiuurihage 18 either pcre ; or it is mixkd with the contimifl 
of lliP clianuels thiijuj^h which it pahse;* to the exterior, with excriMuent, 
urine, nmcns, gustrio juice, air. In general it is cleaner th(f neurt-r the 
bn-mon-hage is to the opening of the cii.\itifB. By tim uriuH it hccomwi 
VGT-j- dilute, csiwciaUy if it ia ali-endy mixt-d with it in the kidinns; by the 
gHstric Juice it in eolnrnd brownish or black; by the vaginal socn*tion, its 
nui^uUtiou is preronte<l, Itarcly dues it come to the ext'.'rior in a fluid 
fttate, but moelly voaj^ulated, in large lurups, or (in the intestine) tu cruin- 



233 



sntpToirs OF n.E3ioRRnAOE. 



blitig nuisseR, or in [leculiar Blinpei) corregpOMtliiig to the looility of tlio 
hn^inorrliagc {f-if^i iifceiiis, iitvti-i-a). 

The CHARArTKK OK TlIK H.KMOKHIIAOK, l>., TIIK (JL'KKTIOK WHETHU A 
1]jGM0»HHA(1B PR0( EED8 FBOM AN AKTKRY OB VEIS OB PROM THB CAPIIXABItS, 
is, ia many c:i8e» even of external liwmarrhagea, with iliflimilty and some. 
times not at all to be detcruiuict). As to whethor an artery or vi'in U 
the canso of a hiPinon-hago, the tollowinjj are, with respect to fresh exthu- 
h'AL lyJL'Kics, some of the oonHidemtioDs : the aiiatoinical pOMtton of tW 
veaselK; tlie thiokii(--H8 of the vrBHeNuall (Unt arteries art) on ncci-iiint of ih«! 
aiiciiiiHti<;s of their couiftn Dot nlwnys rqimlly thick; the wall of veins maybe 
thicki-iied by chn)nic inHaniination); the color of the hlooti (hut in deep uar- 
oosin from chloroform urt^^-rinl blood resembles vfnons blo^rJ ; in tlif Kimol- 
tant'oiiR wonmliiig of ni'ighboring arU'ries an<t v*'iiiH lM>th kimls of blood wv 
mixed) ; ilu* iiaturr of thv l>loo(l-.stnMn) ; in wounds of liii^' arterit^H ami tliuatf 
of medium sixe the stream increases convspondingly with the heart's impulMi 
aiiil oKpecially with ejqtiration, while in sniull arteries it is quite regular; the 
tiliHid llowH from the wins in a tulerably regnliir stream, in the cervical 
veina more strongly during expiration (but in high ferors, aa well as wliea 
the veina at the point of injury are inimedintely bound to an art<>rr, the 
veuoiw stntam also sbows. of course weak. pnltHition. In deep, narrow 
wounds, however, all the above mentioned charairt^rM, as well aa tlie dirM^tioa 
of the woiiml, are not to be depended upon. To est^ihliKh the dia^iosia 
comprcfision of tht* larger vcfisnls inmiediately abovn the wound is eniployal ; 
generally, hiemorrhago from an artery thereby ceases, while that from a 
vein ia by the Barne means increased. Also, the quantity of blood l(v.i 
during a givi^ii time is much gn'ivter from an artery tlian from a vou\. lu 
I'AitKNriiYMATot.s H.^MoKRUAOEs a gi-f-iit qiuiutity of uiixod blood, •.(•^ of 
arterial and venous blood, is ponreil out in a comparatively shor t time J 
the blood streams forth fnjm numlMsrless openings as from a spongH orl 
watering »pout. They occur as well in normal lissiica {corjinra aivenii 
apon;ry bones, eyelitbt, tongue, after cuts, lacerations nnd bruises), as in uew- 
formations (vascular tumors, vascular sarcomata and cancers, ftitigoas grai 
niations). In l'apillary u^morhuages the quaulity of dark bluuil e^'usei 
is comparatively scanty. 

Hffimorrhagca into the tissue of klatorqass ai-eto be rooognized only m^ 
the skill and the neighboring mucous membranes (conjunctiva, noai^, ijiou 
pharjTix, etc.), the blood ap[jears through the surface with a bright or darfe 
rc<I color, acconling to the quantity of the extravasation. ITie skin 
mucous nieiiibrane is nut ibcrehy piisitd ; or it fonns a dilTuKc or c-iitmi 
scribed tunmr (luematoma). I-arger haemorrhages under the |>eriostcum A< 
tcnntnc un insulhcicnt iionrislimont of the snrfaw! of bones. Ijtrge; 
hn-'uiorrlioges into the decidua ttrotina are always followed by abortioi 
etc. 

In INTERNAL ii.EMORRli AOES the question from which kind of vessels th 
blood flows is usually of little consequence. The color of arterial bluod i*^ 
bright red, of venous blood dark red ; but arterial bltHxi stagnant in llie 
bo<iy, iw well as the blood in asphyxia, in deep chloroform narcosis, iu>on 
becomes (lurk red; venous IiIimwI becomes bright ivd in the air, iumI so thi 
color cannot l>e rcrlied on. Besides, most ha^morrhnges are nttt of one pU' 
kind of blood, but, since they often prow'ed fi-om the capillaries of thn 
parenchyniJi, are mixed. The blood coming from the atr-pa&sages and lungs 
pi>»scA.scs an alkaline reaction, that from the stomach an acid one. 

Sometiraea the cavity into which the b^'morrhage occurs becomn t&^ 



nn 11 




BTSfPTOMB OF n.BMOBRHAOE, 



S33 



tended, to a j;reater or leas extent, by the acctinmlation of bload, as most 
fiTr[uentW happpiis in the uterus, stouiacli, ami blHildcr. 

Dlsonl^'i'S of function way ariae frcmi obwtiiictiona of canals; Hnuria 
frtHn olHiti-uction of tJie uretlirn: dyspmea from obstruction of t\m larfux 
and drawing of bluod during inHpitutinn into (he line bronchi iiiiil alveoli oi 
thfi lung, etc. Tbiise ha>intirrb]igt>K imire nn-nly remain latent, in wliich the 
blood acciininlatcs in qnuiitiliefi in tli<! cuvitie.s iibuvo mentioned (Atunmcb, 
Qtcnm). tiumll etTiuiioiiB of blood are tlien altogethar latont; the large aiv 
recognizable oiJy from thfir couiwquent diiw:)rders of funttiun (imnKca, vom- 
iting, etc.). 

Like exttTual hasinorrhagcaf the internal ones, the blood of which flows 
to th(< eicierior, are of interest only with respect to the qiuuititv of blood 
lost. 

II^cMuHRnAt;KS INTO PAHEsriiVMATA are altogother more dangerous than 
tliotKi upon free siirfacos, because in the fonnor the blood pntvcntud 
from flowing away exci-ts its intlncnce by presRure, etc. ; hit^niorrhageK into 
the parenchyma, which cannut extond, or f)tdy to a Kllghily, lui in the brain 
and apiuttl cjrd, ui'e more diingcruus and have m(n'e Hymptonib i]iMi thotie 
into or^UB where evtiMihion is poNsihlr, hh into tho lungs, liver, and spltini. 
ifa'nioi-rhages into the brain and spinal coi-d gi\'o nw to syiuptouis which 
diftV-r wiili the «iti* of the hieinorrhage (waUa of the lateral ventricles, cen- 
tre of the pdus, cortitail substajiL-M, ele.) ; therefi-om fretjuently reJtult par^ 
aly.sf-ii of muscles, pai-ulyHes of Keuwition, etc. 

'I'he dt^gree of danger to the wlkole orgunitmt is in great part dependent 

UfKtU llie VfA-STITY OF BUWD IHU'HEO OUT, which 18 RfUnetiu 11.-8 Verj' KHialL, 

iKimetimeg reaches many |Mjniulx, and u]Kin the time in which the singlu or 
reiMwited hieraorrhageH Uiknh place. ILeuioi-iba^fe is followed by a :iudtlou 
or very quick di>Hih (riipt»u*e of the heiu't., of lar^ aneurisms, etc.) in 
HdultK when as much as five pounds of blood, in the new-born when a few 
ounces have been lust. Or, |Hi1cue.sa of the skin and visihh.' niiicniiH nicni- 
branes, pointing of the no.se, weakness, feeble voice, smnll soft pidse, nanseA, 
cold Kweai, dusky complexion, vertigo, shaking or caiiviilKii>ns, fainting, 
are tlie tmmediat^j t>yntptutn8 which, within a few hours, are followed by 
death (exlomid hiemorrhagcK, hieiaorrhagcs in the puerjveral state, gunric 
and iDteKtiiial hieniorrhages, etc.), or in com i«irn lively rare cn.se»i by rw*ov- 
ery. Fainting ap{M>arH iu adnlts when the loss uf blood occurs Kuddenly or 
qnickly, and U> tlie atnount of alKiut nne ]ionud. I^ong foniiiniing, or fre- 
quently returning small hiem<>rrhitge-s, bf.sid<-s cftu.'<tng tlie littot-ii anted symjK 
Loins, es[)ecially fainting, give rise to hydrsemia and dr(ii»«y (bletiding from 
tlie noae, from the f<-niaie geiiitiils, urinary bladder, rL-cluia, etc., esifecially 
in cancer of these parts; hiemorrhages into various tissues in scorbutus, 
etc; intestinal hoimorrhagejt from the anehi/lontomtim dtiodetutle). Inter- 
iial haemorrhages of eon»idorable amount are usually to be diagnosed from 
tlie aymptoms mentioned. {vld« General Aniemia.) 

A PAVoitADLE I SFi.iiENfK la often exercised on existing orgasm by 
Bmall or mtHlemtcly targe local hiemorrhages : thus bleotUng at the nose, in 
bypertemia of the head, besi"h-s in many febrile diseasc^s ; or in congestions: 
thus the hft-morrhoidul bleeiUngs. In general, also, the effect nf vicarious 
haemorrhages is usuully favorable, t.g.^ from tlie nose, from an \dcer on the 
foot in dclayetl menstruation. 



The DIA0NGSI9 OP n.suuiiKH.uiK ill La most coaos, whr>D the blood dofr< not appear 
to vtov, na. f^g., in ha>morrhagic infarotioiu of the lungs, very ditBcult to estiiblwh, 
or it la impossible, except when a very huge exuravasataoo oocars bi a very short 



i.YMi*HoimnAorA, 

tiino. Tbo qutckiie«8 of the nppcaraDoe of the ^ymptoiuK. tlie ptccedioff and prosol 
morbid conditioiia of other orgims (li(.*art. vcsscIpI, the iuHucuco upoo Uio tc<-'uenl 
dtat^i Iniuuiiiiu, l-lc. ), maHt cuU:r into the fortnation of tJie Uiii{piOMUt, 

Thif lil.^CNOHIB t>K ICXTRUKAI. H.EMtmKITMtK iff freqtlftntlj HOC tO l)« Ulfule With 

oafety without thu a«viiitance of microMoopitsil or chemicsl methods of exiuumatioi, 
eBpociall}' since the bluocl is often mixed with other sulwttauces, and fiiuoo, bosidM, 
the flick are alTi^cttHl hy illituons. or pructico intended »iiDultttiou. 

If the Kubslanco for i^xamiiiiition be tluij, prefembly a part from the tcrritnrjr of 
the veswil inrolved, it lOiotild be Muhjectedlo MiCiinHCOI'tCAr, KXAWlNMTinx. If it be 
dry or Hxod (lilor>) KULiiift), it Hhould b« bronght in contiiot with oue or two droim of 
wAtcr for a quiirter to a half lionr. TbcQ red uDd coUirlciui blood-fflobulcs mid ronipi- 
laied niiriu ari; to hv Miii;,'bt fnr. The red curptutcU-x do uot. for tlie muKt part, Img 
retAlii their cmi'Iitinii in liquirls not alkaline. In the drieil ftnl^ thej' ore eoailjr krt 
in eioiiking' the lilooil b|H)t»>, but a^ajn iippcnr in conc^ntrntt'd tilkaliuu Ki>liitions. To 
look fur ciilorli?^ blood-coi-piiiicleM and Tibriiioiia coiiinihi in llie exuiniuutioii of th« 
liiiuidx iu qiii-'Hliun, t» mostly oi uo uomeiit, but iu blood -otoiiut it ia of the bit;hrrt 
vaXon- 

Only when micninroptctU cxKminittion doea oot or not dearly domoDiitnito Uood- 
oorpuHi^lefl, sre (IIKMKM. procefwea to be resorted to. If the masti in question 
ooutajua an nbufidance of fat. the Inttor h aeparfttcd by aloohol or cither. Then lbs 
laiuM ii« heated, whereby the ulbtlllIiuoll^ sub^iicoa, nluioat always nt the wimo tint; 
pnM>^nt, ar«i ooa(pdntH<l, and al the Ktme time Mparated with the h;timutin. Tb« 
dried residue is treated wjth atcoho) c-onU\iutng a few dropn »F xnlphnric or mnriatic 
Miid. If bicmattn bv present, the solution will be Mddi^h, and after ovapomUna 
will leave behind a brownish mato. Thin is soluble in oanstic potusa and carbonate 
of potiwh, anda and ammonia; inAolulilc in weak acids, and after incineration fu^ 
niahns a hrowniith-yKUow axh^ rieb in iron. Or. a small (huIj of th« ftul«tiUire (thoolil 
be boiled from oiitj-hidf to one minute, with three to ten time* ita t|UB^i' ■ ' ■■. Uc 
aoiti, and enough common »alt to cover the point of a eimall kuKe. At . t'tid 

in colori-tl a dnik s^y- ""'1 upiJcara mudd.v; but &uou it bcet^me* clear, .u. . ._l. .jJI b 
vfry »iiiall i)uaiititT of insoluble RUlwUinee (hieiniii). This uiulcr the mictovoopa 
Bp[)enrq iti dark-hrown or black rhombic liihli-H (U.KMIN CUVaTAI,:^^, wliidi arc uot 
alfectcd. or verr little, by the ditferent reagents. 

Whether thti blood ia human, or beluuK« to vthor maromala, cannot bo detprmioed. 
Wlicii rtd blooilcorpiutclcg of oval form arc found, as, t.g.^ in many simulated 
of bloody c>:|>ectomtiou and Yomiting^, they arc known u belonging to the bio 
birds, or amphibia. 

APPKIfDIX. 

LTMPnORItHAOIA. 

TAMrt!r>nniiA(iiA is a term used to express the flow of Ijrmjih out of Iu 
natunil cliiinncla, tlie lytiipliatic vessels, oa account of woundu or diseasefi of 
tliOBO vc!4HcI». The uxtruviuated lytii|ih Hows pither iiitu the auiToniidiog 
titiautiK, or upon a free aui-fnce. The latter occurs eilber outwurt] (lyinpli' 
fi»tu1n*) or into iiitornnl canala. Tn tins manner is furnicd cUYLors irKiXB. 
which reKiilts from au cffiuiou of lymph iuto the uriimry tmcts. 

The farther coiuiideration of this fliihject belongs to fi|icdal pathology. With rerpvot 
to chylous urine, conxult oapfcially Gl'lilJtK and Cautkh. In a eoAf uhscrrod by 
mytteif there whs. from Uine to time, bcNidea chyhuiB uhno, au evacoatiun of ooSig:tla 
OS long and as thick as the fiogcr, couHiiitiug vxcIusiTcly uf fibrin and oolorless oor< 
pusolos. 

6. DUOPSY. 
(ODRKA AliD AXASARCA.) 

Lowisn. Trnet. <ir- rumh^ 10(19.— Wti.i-ts. 0(>mi »ninki. 1«R1,— TlALKft. S^aid 
OvUatt, 174S BoLiLLAVD. Jouru. dtphynot., 1823, III, p. tH>.— Bnioirr, /A^ 



2-'j 



'«^'* Ihmp. l{m., 1835— MAWENDlE.T^^Wf Ut jJifinjtn. plufs. 
dtla tif, ISIT— IlKSMi. ItffJrL Journ., IMO; '/.t.'.fhi'. f. i„f. Mnl , I«4-|. I.; IHh. 
d rnt. i\tih., II. — Vjiwiiow, Yirrh. Arrh , 1K47, I , p. ."(72' ffnntfA. it. ji/fc. Pnth. 
tt, 7'A^r., 1H."»4, I., pp 4tt r/ iy:;.-C. ^rilMlirr. Afn >t C/mmr. i«48, LXVI., ]i. 
342; (hnmetfriniik d. r/u'iL Vltotmt, IffiO, p. MU — Hkhnaud. C'Mtpf. rrutl. de la 
we. (ir&iW. , ItMfl, I. — AlltJLI.K. Tniit'' drtt fij/iln'ju'ir/i et tie* tv/MtrK. IKfjg.— Blif^KE* 
BBI. ot RoDiKk. G<n. mrtt, IHW.^MlAJ.llK. i'iti"n ;;» (^, lM3.~HarrK, IVrnfr. 
ArrA., 18.W. IX.. p iM5, XVI.. p. 3111,— A. SriiiiipT. AirK f, Aiuit., f'Atf»., vU- , 
Itftfl. pp. 545 et (Im'j ; IHi;?, y^,. 423 et .*)a:J.— Tompa. SiUhrr. fL Wwi. Jr.i./.. IK«2, 
^ ]?«.— LuDwio, OatUrr. Jnhrb., l*W3, p. aS.— O. Wkhku. ^rfA. tf. Vkir., 1865. I., 
p. IW. 

Dropsy in the morbid acciimnlaiion of a fluid more or Ictw like the WockI- 
BeriDii linii U-nipli in tin* ]iiirpiic)iynm nf iliu tlsKiK's iiud orgftns, or in cl<wd 
iscruiiK cavities. It is (li']n'ndt'nt chicfiy on »li»oriJer» of the ciiculutiou. 

If dro|>sy uirect tlie parHiiclivma, it. \& called: icdkma (uhIuiiiiU/hik nr 
dropsitMil iiitiltfution), asarahca or h>'j)OBaro», uqiut Interr.ua, If it Alfect 
clotted cavities: okopsv, free drojwv, bydrojwy, dropsy of cnvitic'K, and re- 
iM*ivcx Hpet^iid nututrii from tbtt cAvittrK iLffeclod : liydi'o-jKi'itoDeiini, n&citeu 
simply, ahdoiiiiital ilr>>pBY ; Iiydnwllitirax, dropHy of tlic iliomcic cavity; 
faydro-|it>riLiu'diiini, droiiRv of tbe penfurdium ; kydroerj^iudun nttrrnus 
ftxid /(. inUrHXts, h. cenlrolia, Kydr**p» centrictdoram, cxtoniitl iind iut^-ruul 
dropBy of tUo liead; liydrotclf. dropsy of tlie scrotum; bydcortliiufiis, 
dropBy of t)ie joints; hyilrojiIitlmhiiuB, dropsy of lliu eye. 



I Contrary to th** umin) rfi«fnm of upeiifeing-, llrgutcl pffntion into the cnvitie* ot ihe 
nlveoli tif th(.- lungn in trj'litioiuUIy tinned ptiluiouury asloma. CUdcina of xhv. plat- 
ti», so-callM. i» tiiure rarely :ui a'tlffniatom*. moinj (n-quently a ftcro-iiiirnltfutiuflltra- 
tiuii : it liyi-s aot affuct the gluttiii, hut tiic fuldu of muixtus mciiibnuie at the uotinuce 
Uothe liuytix. 

^^©i-opay is either lwal (dropsy of any cavity, wdenm of an extremity), 
or it alft-'fts Ui«i"e or let** the whiile bohv (j»ciifml dropsy). 

4£itKMA • consitftH ill a PATiioLOGirAt, acciijujijition of i^imiatitativcly and 
quHliLitivoly chaogvd lymi'li in t)i>> lymphAtii- radicK'.t, uUo in other S|iftL-e8 
within tilt* tissues and withiu muny cellular and tihrous tdemcnts. This is 
proven by expcriin* nt, as well a.s in jmrt by put hob )}{i co-anatomical exami- 
nations, Htid in nioHt cases by the a'tioloj^y. 

KxPERiMKST tlenioiiitrntcs tliat tratij-itions occur between the naiial con- 
dition of tissues and «ed«Mitft. Also that in aniniaU by conKtricting the lips, 
(rdenia can bo produced ami the liquid bo removed by the lynijihutics. 



The exi-ittnoe of spaces lietwccn tisfluc-olonicut* fille<l with a vnryiop quantity of 
liqiiid, furaUhcn the ^ount] uf cxplaimtiiiii n«t. merely uf tlie so-callv»l tonmi uf lia- 
eae« free from mnxclfM, but also of the flight, ttnarcely recoguizahle degrees of (utle- 
ina: palftDOM nf the faco aft«r night- wiiichiiig, etc. 

In the lixtnj; aDiitiiil aTt<'ma piwws away l»y the lyinphatk-s. If a lipituro bo 
applied to the aiii>er lip <if ii do^*. tJio lip will Swoiiic very a"Hr-matoii« ; if tlie lipta- 
bo removed th« lymph will flow very abundantly from the opened cervicsi 
Is, whtle the oedema visibly disappears. If the lip be prtsaned between the ttn- 



"TThe three temia DROPmr. ASASAarA, ami ccdkma are used in l-'n?nch. En^rlish. Rnd 
I Amcriraii l:OoV» tn a somewhat simpler and more definhe mannrr thnn in the text. 
I Dtopity is the generic term ; auasuica la a tcenermliied dropsy ; cedvnia a locaS 
I dnjpey — [Ed-I 



ORTOIN OF DKOPST. 

gen. tbo irflappeorance of tbc tcdema aud tbe Ijrmpb-carrent irlU be liiuiiltaccoadjr 
occfJcratod. 

CoiiHiill the fiX|M!rimfnt!* relative to tUUt nuhjvct by Lil)\vio an*! hi* {mpTU. 

Thi! une(|aal (lir;]Kmttt<in nf ililfttrrnt partf* to ii<dHma fli'jKTidii pnitiv *^ii Uti dif- 
ference in rirnitnihl-uuct-a whieli affc«:t tim piusxi^t of tho lymph from out of the 
tndieli.'K imo Lhe mniii braiiehr-B Thin latter U dpj-t'mltnt iipou tbc elastirtty of Ihr 
\ra\U or tbu lyui|)h-H]>3c<?!), thoir iuu)«eular cliaravter otid tbt.' it-t^reu of tilliiii; of Lhc 
oelii Bud t^lamU borUuriD^ ujkiq thotu ; atid too upon the resistanct^ which tho Ijrmpb 
inec'tH with, LhoFi itpun th» diin(>uiiioiui ot the apertures, tbu h(!t|r|it of tli» utlunm of 
lynipU, iind ilns (flnndM tu \m tmv> pm^iL The skin of the fiu,tt is *wit^ DiKm liy 
niiUHiIee. and froin il lim lyuipli llows duuuwanl; thr skiu of the lowur extreiDiUei 
IK intivided with fcvr uiiude^, and the Ijrtnph muiit fluiv iipwanl mnd throucfa many 
glondB. (Lt'DWIo.) 

Patholocico-anatomical INVKST10ATIOX8 Ukowise prove tlie alibve- 
luentioiieil cuuiiectiua iK'twet^n a'llfiiiH AtuI Ibe arrest of tlit* lyinjili-flow. 
CEdematoi's inpilthatiox ttliretH pix-fenibly tlie comifctivo tiKsuu, i-urli^t 
aiiJ iiiost Mtroii(;ly tlio areoUr tiMiiif (tH-tweftci \t»>si'U, iiiusrl(.-.H, ihifsltnfis|, 
tlie 8iiI)cutajieous conncoLivu tissue, the submucons tissue, os|>t_'ciollv that of 
flie anl<lc», *'i,i.Oii|t(, male gi^iiitnlH, iindor wrtain circiiinstaiicos a\w> (bat of 
tlie iithIh, uf the aryinio-npigliittiiT lir^iuni'uU, ptc. ; lati-r it afU^rts the finu 
conuc'ctivo tissiie and pftrts consisting' of it, f.y., the piamutrr of tho braiii 
aiul Bpinul cord, and mucous meiiihrniit>s ; fHrthor on, smooth udJ sti-int^-d 
nnm:lnH, t)t<i-vi>-tiKttiir*, i-MppHalty tin* biiiin, glnudiihir »rgniiH, lut thn lym- 
phjitic gluiuts, liver, kitlneyg. (Kdenia docs not occur in firiu, lutixtL-nAiblo 
pttrts (conipout subataiici- uf boue, eiu-tlluge, tendons). 

Conoormttji: the nmonnt of water fa the brain In typhoid forer. we BuQL, Z, /. 
rat. ifeit., lUR'i, XV., p. aW. 

MirHDsnopiPAi. examination of offdomaious juirtH wholly or cliiofly wm- 
raittin^ (d* connt'clive iiKHUti mUows tbp conni'Ctivt; tiiutit.' filfrcii scpnrAted fmni 
one anolhcr tv a, gii-atvr ur hjus extiMit by u lifpiid souietiiue.s veiy |>oor, 
KutnetiiiieR veiy rich in lyinpli-eoqiiiscles, cK-ar, or giving wirh uU-oliol u 
niob.'ciilar cOiiguhition. The fixpii connective tissue i*orj)\iwlc(t un? olU'n 
lai"m?, uvhI or tladcni'd. The appHaranrcH mri'ly lead to thu iiifurfiico of au 
undoubted filliug of llie lyni|diatic iiipilhirinH. Foi* t)iu most part only the 
udventitia of the veii&v'Is ace ujul-Ii di-steudrd and se].>ur.itrAl from (he V(.'atM^U 
to which thoy belou;;, t:'siK'cially in tht? nitu"»>iiK niejubraucb, and in tbi.i bruiu. 
Ilonce tlio coonL»ctive-iiK.su« til>r<'s an- fivipiniiHy «oui*'what clouih-tl. The 
histologiad ii'lutions of the n;tuainiiiy (I'dfiuaUuii!* lissuoh, i'.s|«'cially of thow 
consisting of cells, arc: not yet sullicifntly known. EpiiheUa retast for a 
Irtng time th« di«tontion of theii- baws, until they for tho nn-Ri |»iirt nadrrgo 
atrophy, raiidy Wi-otningtedemalous. A similar simple atittphy itt (exhibited 
in the gland-crlU of the livfr and kidneys. Tn the tht-ceJlK the fat bt^omn 
move- and more scarce, until finally the cell menihraue conluinn only tiic 
Ducltius and serum. 



\V. Yocso (Mien. StUriJihfr. , 18fiS, May) oxamined the (edemototui akin of th* 
•Rrotiim. Kngnr. knee, th« lyniphatieji of whicii ha hud injected with I'l in..i:iii i^tae. 
My thin tho lymphatic* in llic corinm were found to oontdit in u»aii> hi; -clt 

net-work, uiid in the oppor liyors of the coriuui Hmiwd l.iy fjittbrliul > in 

t'le tower layers by theMi itiul an claHtie network. In thv tipiKir Layers »I Lhu conum 
Ihry are aravmipanieil h^re and then' by one, in the Inw-er liiyitm by tw<» IiIn.«lrp««rJa. 
Clo>>>lv[><t8i.>lM mkHlarntheil within lyinphaticM have not lM>en oliM-nrt^l 1 ■ ' >' 

(I^d«mnlou8 fluid is found L-hiefiy in tcimccn thniu(fh whioh pasa coi' i 

bundle)*, isulitted conueotive'>LiiMtie wIIa uud Ubres and which are luiu: .^ -i ■• 

Bpeoiul ineiuUrauc, but by one f<.iriued nearly of e(atbeUum. In thes« Kpac«e tha &«•« 




cnA5osa i» tiBorercAi, parts. 

TOnc"^, om] or wmcwbat spindlp-shaped cells (miprntiDg or exudation ccIIb) are taani 
iii'M ultuiKJnutljr ut-nr ihc blood ves&eU. 

Ai'iording to RANvtKK iCompt. rfiid., 10 July. 1H7I) tlie 1>undlc!t of axloninttnta 
coniitctivt tinnte arB after l-T-UO hourH ttc j-nratHsI from one aiiothrr W n clwnr spnini ; 
m this tloat nurnvioiH white bLN^d-ftorpiiHclfM with Mnn^lxiiil mtjvumrnt". The fixed 
ci«ineL'tive-tis«i(* wlls, which in Hie imnnftl stiiUi iitp flnt. hyiilin**, larjfp snd )tti'Ctch«d 
on thf Hurfao- of the LionncctiVfj tipi?«int hnmlk'S, nrv Hplimial and (illwl with ttToncly 
tmtnclivv frmiiQlos. The fnt-celUt aroimd Iheir clinraetprUtio fitt-dropa show Bimtlftr 
'fttronfcly refructivn jprnmiletii, r»tenib)int; n AtrJa^ of pctu-la Thu u.n|iillnnL>K. like the 
nnall TRttis awl nnfripR, arfl dihtondnd hy IiIckhI, thfir inner surfwo coTpred with 
nunit-ioiin vrhitQ noqmpcjen. Tho yrranuh:^ nf i.hv fixe«l ctmnective lisrae wIU, like 
tbo«e of tbfi fm-cjUs. Are round; they rufmct tlie lijrhr more rtriiiiKly thau aJbiiuii- 
nous, loss thau fatty ttnumles. \Vit)i uu^tic ucid. etc, they hucoaic ttuiUlur, tnore 
strongly refiactivt;, nuil reaeuihle fiuuly-divided fut, 

I>BoP8y «F SEKovH CAVITIES U likewise a pathological collection of quan- 
titAltvi;ly and (jitHlitat.ivHly cliiiiigt^) liijniil. lit imt^t of thniw oavilin.s tlinir 
coriirnuuicHtioit with the lyniphiilio ncl-work, and th*.* (ttkitij; iipnf tinid aiirl 
N'di'] .Htil)stiiui:ea into tht; Intti-r, has heeu (^xperiinentully 116111011x1171(4^]. (Sen 
p. I5ft.) 

r^mjuilt partirmlarlT RKCKi.nsnTrACfiES, Dtbkowpkt, Lmwro, and BrmrBTooER* 
SEiDfcl. . firr. a. S. Annt., ISflltJ. 

The serous membrane in dropsy, when no coinplicatiou (inthimiuatinn, 
etc.) exist^i. tire jmla, aiiieinic, cluuily, thinneil, or sotuewhut thickened, lean 
eUstic. Their piulotheli.-i ni-»* mure t-aHJIy Hfjiarali'd, of(«u iiicrcaKed iii size, 
of losa regitlar furin, of a (iut'Iy j;niMiilur »|nifAniiicc. TIio lytnpb&ttcs ore 
not iiifuHjiiontly cicurly dilattiil. The tisttue of thn scruus lucnibrancA snme- 
titD'j^ oxhibiu falty tut't^unoi-phojiis of its c^dliilar elemeuts, olherwiae 
nothing abuornuk). The umscuhir tissue surroiui<liuy them is pali?; after a 
lon^^tT duration, it becomes affuctcd hy sinijilc atrophy, or by fatty degen- 
eration , 

Tbt> chan^o in th<t hrnin-Knh«t-arc«> nhout the vpntriclpn in acute hydrrvrpikhnlim are 
for the most jMirtnot efff-ct^ of the dropsy, hut concomitant offecti' of th« inlliunnin- 
tion. lu ohronio hj-drix-ephaluN, oxtontully (ojdenia of the jiin-mutpr) us well as 
inlenially. o diuiinntion ii> ohoi^rved iii the rtize of the bniin-ina)^ to so jfrcatan extcot 
that it hcfiimwi rednivd to thw ihirincut of iiup4'r. It it* tiiprf-hy not infn'i|upntly 
reiideriMl firmer. .Soine(iini>B, hnwt'ver, sDftPniiig nf tliu sHrronniiiny timln-HiibHtanL-e 
occurs, whii-h pirrbaiM in cadaverouB in nature. 

Vt^ry '■■imilur to dropny, hut to be di.>ttiu^niUhcft from it. arc: 1. pai.hc dropides or 
cyw. tt-hi>-h r>;^ult from cliviuro of ihi; itxurttory diicL>t of ceitnin K'^u^i^nlu DTgiuui, 
mocnuR membranes, or tfirrrtirtih at norinnl niui:nn>t inpuibranpn, luid which, oftvr a 
lon^T tira»^. (\->ntain only a fteroun or (Kfro-itin<:ont liquid with or without truces of tho 
f«>f7iicr nrinoid omt^utB ; renal dropsy or bydroncphto«JK; dro|wy of the fnill-tiladilor, 
Fnlh>liian tubc<H. uti-rtiH, vcruiiform process, lachrjinKi one; the cyM'S arising' from 
•«kwurfc of the e!ii:ret^)ri- dtiL-ts vt macoua jflnmls. 2. WATKitt siccUKTiOKs on vkkk 
~|ffKirACKK. twpeciidly of mucouM mcmhnuieH, £.^.. uf the- ijit«Mtiual cuunl iu many 
MttArrbn of that tnbp. in rholnrn, vi^i. , an well as of many gInndK {f.ff. of the HHlivary 
ginitdft ill salivation). In Dot a few caxoa, dnriuff lift} an well oh aftnr death, it in im- 
pnaRiltlo to Kiy v« bother the sccmti-Tin, ^.3. of a pun-nchyma or w-rouM envity. ix r 
TBANfiiri>*Tios (dmpsicnl liquid). orlc.\rD.vrios (sto I^^•l.AMMATI«^^■). No s-h.\ki'Lv- 
IiEKlSKri LrxE pkpauaths thehk two. 'riiu llipiid of bli-iter veaieles. e.g., is 
V'T' ■ -.nuloROTW only to blo*id-««nim, i_i; rflnliv«ly rieh in wilu. iiKKliinitAly 

a! t)Ut very poor in fibriiioRencorf pulislauce; nonie limt?, on tiu- ntbtjr liaixl, 

it ^. ---.- ..^li in albuuu-n and proi>ortionalcly so in flbriu. The teiideucy of the 
liqnid ti) coa^iJnte iHcri^Aftt;s if tbu »l\mf. part be subjevtcd to a quick euooetisioii of 
blutcria^ ; for th« rt^iH-alfd irritation ix ak.M:om|ianLud by more uxlvuded olroulatory 
diatorlHUioea than a nngle initatioa. (0. Weiulr. j 



338 



JTATTRE OF WCTtK 



The LIQUID ill PKOPSV, ckdematoi'S or i>rop8IC'al tbansi'Patiox, I* coiw- 
less or light yellow, clear oiitl trati-sparent, of insipiii or slightly salLuli 
tiiste, will) Hit ulkuline, very i-uiely with mi itciil ruiictLun^ and wlih » Bjiecitic 
gi-iivity Hiightly hij^'htfr Uiaii that, of blood-Bcruni. 

Its CHKMlL-Al, fOXSTITL'ESTS &ie t 

Watkk, about US ;*;; Ihiis in gi-euter qutmtity hem thnn iu blood-serum 
{which coiilaiiis ubout 91^ of wutt.'r), K'^ in ohler ]t(|tii(li. 

AiiBl'MEN: next (o wnter in itii[M)i'tuiice in iiiukI droj^iical H<tui(la; iit 
very RiniiU qiiMitity in thn drojisical littuids of tht^ hiuiii auil 8)iiuHl conL 
Its quantity Btand^ gt.'uui-ally ui invejtiu proiKiilion with tts salts, iii tklmiMtt 
dirett ratio with ita contoimnl fibriuoKi^-nouR substunce. In greater ijuaii- 
lily it ill the cause of the viscidity or frothtuess of the Uipiid. 

G. SctruiPT in n case of Brlj^ht's dineiuc found S.S<ff of nlbntnoa in the liqaid of 
tbo pleura, l.tl);; of it in tli:it of ihit periuiiipiim, 0.6-n H{ in thAt of the enr*)bi&] 
manin^eft, O.oO;! in thnt of tha Biil>cntanpntiH cullulor timufi. If bIdo ibRte ctuanUtiR* 
t^ry in different citfKs. the pn>i'nrtinti uf tlie idhumiuoiu uiintoiil^ of the uontinilalut 
in dilfercnt localities in tbe iMime iiiilividuai alwjjx mnuiu^ tiip ^anio (IfolTK. I. 
Dl.. p. 241 fX 2-'>yi. Ui'siOt'j*, linPi'K f,Jif>iU''fu- h'UuH. lS>:t, p, 44; Ti'f^A Arrfi., 
XVI., p. iilM) fuuml fur tlm iinwt part, the triinBuriftl<'j» in quicJcly rRiw-atMl pnnrtnicsj 
Ion allniminoUH; morf* rnrely i Vir<-A. Ar--h., IX.. p. S4<>t waa th^ nlhiiineu tnoroj 
ftbundaiit in the aecontl puncture. If the qunntity of the tmnsndat« ami llie pr^MsmJ 
bad tnoKosed. Uoi'i'i: fouud iiuudeiuu of bUc feet, free from blood-coipaadcft, oaly^ 
1.7% »oIid ingredient^ nnd unly 0.:{; of albumen. 

The quantity of nlbnmfn in rloppndent : I. Upon the capillary «y«t*»ni . by ■< 
of which traiwudation t«)cos placo (0. SrUMtUT); 3. Upon the i\nirlcn<>es of thel 
blood -circjilnticin, f^o that tho t>ranHUilaco ib ricli in nlbnmen in dirvot rauo %ntb tbft 
8lown€««<i of tLe bl<x>>] circulation in tbe cnpUlurlo iLkumann) : if tbe cirLuJattun in 
tbe abdominal veins bti consiilt;r;ib!y n'-ttinlod by lar^ tumon, the preaxure in<:rua«i«t 
and albuTiitm in birppr qnantiti*?R will be found in the tmnHudntf. than whmi mpcban- 
icfti hindmnoefl of Imw impnrt-aiifv, a.i e.ff. affertion* of thy liver with coutjiactiun at 
tbe luroncbynia, etc., arc ihe onciuJon of a hlowcr venouii circulation iIcm eloTUicoi 
of pre»aure) ; in ncuL« hydrooi^pbulua the quantity of albumen is irtcaUir than in the 
chmric form ; 8. Uiwn thf. chnracter of rhe bloix! ; tbi* ponrfir tii« Wood is iu all»u- 
niDii, as f 0. in Bright's diseaw. so much the lew in fuund also in tho traiuradate ; 
4. Upon the durutiuu of the dri!p<y, kiucq in long duratian, and front •'?•■ ' "ir m\ 
which Ibc preMuiT of the traUKudate and that of tbo tilood become • ^ilL 

and water return into the blutjd, M'bilMt t.be albumen, which can |>cu< : ' ^)tf^^ 

membrane only nnder pomtivo preiwaro, reninins behind nud bcoomea rvJmUvely in- I 
tfreoMd. (HorPK ) J 

Tbe rouooue eoiud«tenoe, which the Hquid of ovarian drop«y often i4ion*K. Is uotl 
dependent upon the preaencc of mucin, but upon Unit of peculiar olbununous bodlas] 
(metalbntuuu and |>nralbauieu of ScuEltKRI. 

Finnnr, hh sneK, i.e. an ix enmhination of fihnnojilftstic with filiri oogenic 
substance, Flocculent iu foiin, nr as a tiniform gL>1:itinous !tuV>stiuioe, seldom 
oocui's in dropsical Iit|iiid9. Sometimes it is accreted only after long sIadJ- 
tug. Itiit hH trnnHudat^'H contain, for tli(^ niiwt jmrt jirc>|tortttuial to tbe 
albuminous cuntenttt, ther«<ft>n: in very Kninll quantity, FifiKixo<iF.xro si'B- 
»TAX('R. Kibriuogi^n is moat abtiixlant in the liijuid of the pf rifordiutu, and 
of liydrocclo. It ii* not seci-cted in solid form, bccanse the tibriuoplastic 
BubKlanue is nut isimidlAnrHnudy prettent in (.he tmuRudnte. Tim latter may, 
by the addition of blood, ttlmoat instantly be coagulated. 

BrmirDT baa examined In nil ^!t tniitsadat«"i with re<)i>et!t to their Sbrinuaity ; 12 
li(|uidH front hydrocfles, 42 from the pericanlinm. 15 fr<>ui tbe pleunt, D) from the 
peritouRum. I from the eerobnd cavitiwi. 1 from tlie celbilnr ti'«iie of a ni'w-bom 
child, 'i from blifterfi, I from a byBTomntons cyst, I Tmm a rpdieie by cold, I a* 
erynovia from an inflamed knee-joint. In SI of these caaos coagnbitfoa occanvd 
through contact with blood. In 11 noses cootfulation could no ton({or be prodiUBl 



WATPRE OF n-rm. 

ITeve, liowever. exTiAutttivo hvraorrhagvH wtiliin lite ivAy "Utm/BBg^yoctnujvi} (tu 
the liTing body, or in tfae dead body, io that the tfuniin lirul idSjHWuva^h the dead 
vmoiiIaf wallnt, or iu its eh<Ki|>e daring Lfc ur iltuiuK Uil* uutopnjr the bluuil hiul in- 
ductHi oor^mlRtiun. Tliu i;ic4ilL-t nunibtsr uf i*xoe)ititiiiitl rtumt in uo wity ouncem 
liiiuidn poor ill Hbnii or iilUiimcii : LliuMe, un thn oontniry, wnru cniinirntrAteil. but cumo 
from orgaiut which Ixfor*.' d-^itth hinl suffrrcd from iiillmiiiiiaiion. \'wy frKi|in-iiHjf, 
liquidB coo^ilntf siKnilant'ouHly afur Uivir fJVtipc (i<iui tUu tUitd body, tisuully alter 
their Hecrctiun froui tbo IkmIj- luid taken place; thay do uot ii)i|iuar litforu l-l^hunra, 
ofl4:ii not iini'il lifter i<-IOda)fi. 

In the lluidx of ibo dfeml ImkIv coB^rulatioa n«v*r fnUtt, nt Irast io the exttnt of 
ftltght duiidiiii:*^. while from liiu liviiit; ofUtii g-t-rft^ctl/ cltmr ilbtiiioiis liiiniilp aro 
taken, whit-h, until puLrBfiiciion bpijins, n^uimn frx-c from all siiontniicoiis e.iiij,"ila- 
tkm. It miiit thercforo ha nsNunicl, that in the dccid Ixtdy coAfcxiIatioii lukvif pLoco 
becAiua of Lho }ili(;bt traiuDxIittioii of 6bnii<i|>liiM(.ii: HiiVrntJiniA thmiiifb thu dnnd viix- 
eular widls. Coui^'ulation witbiu thr: bwi; in «lTiii-t<:d !>,%■ the bln(Ml-8cnini. which 
trickles tbroiiyh thi.^ vai>ciilar wall«, in lymjiUatic dr(ii«i«tf i V'lncuuwj through accena 
ot bliKKl daring o{ii>raliuU8 or aiiciKly Ui:i'omx>Iishod In the body. 

I'uitcLured. qaickly madt- lii anccc-saiiMi, of dropHicul norouit cavitTei) ore gcuemtly 
fuIluwuO by lui iactcusu uuL auly of thu ulbuiniuuius but hIho of the Bbrinotis ix>Dleilt« 
of thu truium<bi.t<i iwd p. 237). 

Aocuiding Ui Naisvn (!i'?rp. niM. Ztachr., 187(K I., i>. 174), tho trurumOotcs in 
ovarioD oyiit«, in anijrloid dej^oneration. alno thutte of the periLuuouin, aru frt-'ijuvntly 
petfeoUy dcnr, or only aliyhtly upiili-!K.-(;iit and not vi»ooti», of very low rij>t>i-ilU: yi-iiv- 
iCy, coagulate vitht-T ngfjiitiikucoiuily ur af tor contact with Siiriri<ti>liuttJcsiihnt.;>ii<'.«, aiwl, 
wli«n boilird after niudiliuHUon, do or do not let fall albnu.en, and rrduco nikaliiio 
M>|ntions of fO)i{icr. 

HSHMt illtih fl.Atutu, 1871. III. n.. p. 81S) chsnciarizM the Buhnrmflhuoidnt 
eaiuie<-) ■ ' mi'(.hi?» na a pbywolofpcally dropsicnl oouuetrtive tiii«ie. 

Thm tu . I loacbi'A Dhuiuivally iuohL iienrly ihi: liiiiiid of tMbtnimloiiJi 

ootmei'L..>.. . — .. . .1 .......iU.H. in oouLrkHt with tJio liijuidii ut tho suruiin ciiviliv* 

(pliinra and iHjritonontu) fuw solid ingredients, Dniocly little albunieu oud DO flbriu- 

EXTBACTIVK MATTEim. In varying, for th« most part |jro]>ortioimtely 
largo <|ii}iiitily. ]iii>piit'li(piiute tu llie Hgu of the tIrupNicnl IliudH, Honietimtis 
antuutittug to •l—fi.fi'i »>f the HJhnmeu. Tlu-re btg prehcnt ucitoring matters of 
Utiknowu imtui'^, which urc the eaunn of thr- <.lttri!rcnt culoring of the liquid; 
soniciliuoA the coluriiig nmtti'r of tlie hlooil uiid bile. 

.Kat8, in suiull «|iiiiniit;V iii retwnt, in givati.-r tiimntity in old dropsies; 
»linu8i ounstjuit in suntU qimutitiott, ufteu in very Largo quantititw in ilropay 
of thfl sciotiim. 

I' BE.*, uniforuily jnesent, in large (quantity in Brij;ht*H dtacaae. 

Lactic acid (in pnL*i'(ieral fever), iiuJ uric aciJ axa uot iuficquMitlj to 
he nH!(tgtiiKL>U. 

Xunlbiii, crcatin, ntul crtrjttiuin arc occBfliouHlly prt!4ont. 

bu.iAitv HALT.S, MA Well tus Uie culoiing nmlU-'i' of bile, in ilrojMy through 
di.HenMit of the liver, luul diKeiiRt^s with ictt-'ruK. 

Kt:iJAit) cniiHtant in iliulHttc-if ni<.-llilUK, otlnTwitiu rare. 

SoLcitLJE SALTS, eii| wciul Iv (.'hloritk- of Hu«liuin, WifiiJea carlionatcs, f^hos- 
phatcs^ sulphates, mostly of sodu, in less quantity, of jiolHiiHti, litne, and 
uiagaenio, ani uUuys found in HUuost the same proportion as iu btoixl- 
serum, iu quantity proportionnte to the water ot the bloud, aud to the rich- 
ntuis of the ti-antitidnte iu albumen. 

In Bri^ht's diftuinie, the iiaaiitity of tuilta in the tmnitudale may outwt>igb that of 
the frgautc nintnial. In bydrouvpludu!!, phoHphutuM und comfioiuidii of jH)t<u>>>ium 
preTaO. (C. SrilMli>T. ) 

AiiMO.MA occurs iu tiwiKudiitions^ as in the liquids of the body, ut the 
tuobt iu extremely snudt quantity. 



230 



WATTRE OF FLITID. 



GASKd, du'bonio acid, oxygun, and niti*ogen, in Bimill quantity. 



I 



fialliU. 


JUIiiunca. 


FUvln. 


OMk 


08,40 


81.9^ 


8.ftfi 


H,5\ 


ftJ,40 


n.ea 





R.4.1 


128,58 


0».6U 




lO.oO 


00.80 


45,fX) 


tzwica 


H.W 


70,a5 


01,is5 


** 


H,.1» 


50.112 


49,HS 






84,t« 


3<t.74 


0,'10 


m: 


IM.BO 


»>.13 






ST.."*)* 


i7.yi 




H.ll 


ID.Ot) 


18,»7 




8,34 


18,«4 


S,I6 




B.aj 



XrtTlMAL l.TitPR nnnsista of a oolorlew plnnma miii lymph -oorpusclwi, (ii -vtAX ta 
for the most part of fiuc oil-^nbnlos. Plaitmti contiuns flhrinngcD nmi ttbriuopliLsttc 
KUbjtt'incd (Ltie latu>r in ktia ((uauLit.v tbiiu iho hli'>od). »-» wi;!! ui, with thH eitM;pt:ica 
of thf oi>Itirin}; uiHtU^r, thti reiiiniiiitii; uttitstituKiiU i>f the bloott : wut'tir, mlt«, albu- 
minaUsA, iirotngmi. fma, urea. pstrHi-tivH nmttti», wiffur. 

Th« f<illu«'iii;^r tiiljln Mbovv-a tlie COHrL>»ITH.t\ OV SOMli or TUK TRAJtSirDATea, Qi 

oomparisou witii tlutt uf bloLid-pliu»iiia, etc <0. Webjcr, L c, p. SIq) ; 

Biofxl-plamnii........ noi.ril 

BhKMt-aenini 007.W 

Pus 871,00 

Sccrctioa of wouDils U3t>,30 

Liqaidof ItWstezs 9:r2.1t8 

'• h.vdnH.-ele.*., U4O,0« 

Ptenral tmiunOattf I)4<'i,t5 

IVriwmlial " flIW.lI 

Peritoneal " 1HI3.((7 

Anoaarc* " 0:)0,»7 

Cembro-spima fluid 9tiO,SO 

The duid ^m the hip-jnint in b cmb of arthritiii d^ormfum contained 23.fi madOt 
S0,9 albuminous material, Hfi inorgaiuo matttir, 043,7 wntor (HuPPG-SKytSU, VtreS. 
Arc/,., 1872, LV., p. ZoU). 

Tlie Miciiosc^Plo Ei^>rKKTS of tniii8udat«» are Vtny few. Tlie only 
elements whicii iire essential hiuI c-on3Tant, but in vunubk* i|iiiuitity, «i* 
the i,YMt'H-L'OKPi'srLE.s. Tlv tlio iiiorn recrril kuowlcd^^r- tjf thi-ir (.-irciilntion 
(nee p. lir-), tuul of thv jpiitliugiMifsw of (in>i>*y given iibove, tlieir cun^tiint 
occiirrt-noe, as woll iu wdema as in dropsy* is ea-sily exjibiiiitfil. E-VPn- 
TQKLIAL fELLS of the alfwted s<iicmih nioiubranes, ooun^Uuiea ubystau of 

C'HOI.ESTEHIN, etc., Hl*t> AITIPKNTALLY JireS(>nt. 

BomoUmcti the (Iropnical fluiti has a TitiX Mii.KT oharacter, csiiedallj io the abitf 
minul cavity ; it pfocce<I» vither from a mixture of fat, or from n f)ei?iiljnr cumliioa- 
tlon of albumen (A SfllMinr'M molcculor fibrin). Rnmetimca th« character of the 
tmuudate ia that of a thin mnuuit. 

Causes of dropsy. 

Thp cAusnH nf dropay in geueml are nlways chancko cosDmoifS of 

CERTAIN OIlOAJiS, or of tlie BJ.'>OD, Of of DOTU At THE KAME TIME. The 

affected organs, particuliuly, nrv tlio In-art, next the viins and lTni|>bati(*», 
the ki<Inpys, the lungs, and tlio liver. The blood-chuu^t** ciuiKiKt in ii 
<Iiininutiiin of albumen, and iu an ineroaBO of nuier. In ninny (yi.-»r» oj 
dro{>sy the BLOOD-riiATfUK^ nre dn|K'iidonl npon a i>KKDiap<jaiTii>N, while n 
MEcnASiOAL ciRoiiMaTANr-E dftt*irrnino8 the outbreak. The tneeJiauiol 
condition conHiMtH idthei- in an inci-eosed ttliatraotion of fluid fnim Uir 
M(kkI, or in an absolute or relatiro diminution of the rcsc»rptioii of the 
exoreted liquids not used in oe-Il-fonnation. Increased sepai-ation of 
liquids depends: either upon an increase of load blood-pressuw thix#U}!li 
arterial, especially* howevur, tJimugh venouM hyponotuia; or, n{K>n h diiiu- 
nuliun of the tension of the tiit^uea Rurroimdiug the capillaries (fi.^., by 
the citp]>in<;-glA8S, or Junod^s boot); or, tifton a relaxntton and rt^iilting 
gi-pjitur porosity of the vascular walla. Dimiiiisheil rtjsorjition in dejiendent 
upun an iucrva&tid local btuo J -pressure, as well as upon the cliaraet4>r of the 
li<]uid. 




Imoi'fiY. 



231 



nth Tewf>w*t to >il«>od.chi*nge'», the <lropw"ciil or »«rou« ora»iB, which w a conse- 
qucntw at clrnjMj-, tiiiiHt b<< (Unlin^iitliNi from lliu priinnry liliMul-ohuujpiH wbiidi ate 
the caosc of flmiwy. 

Tmiuudniinii IB a >"n.TIt\Tlos fif tilooil-»i«?ntin tlironjrli the enpilUrit-s, wimniog 
' miller iucri-:iM(i nf Lht^ pTusMure in the viu^ciilar sy^totn. All tt)f< tnity ili»w>lvt'il 
, tnatutni of ihe IiUkmI, an mlu. fat. tmio. )iiu» throngti tii Mil- !<nm<3 proportiuiiF ru 
I ihey occur in the bloofl. Tin! miitt^-M not in tniH s.ilutinii coiicainml in the blooj, 
yfe allmim-ii Rnd the QbriuO},'cnon« tmltitttincL*. as well u« the c<iq}uwiiUr elements, 
IHk tliruitifh iu tituub k-aM<|iuuttity. Bet>i(]eHlUlniliou, Llin \avnt of UIKrt'^InK, of th^ 
rtniUfTchcuifirt^ of tliiiiJK Ihroiitfli nu-intintiio, eut'T iutu txnmul oration. Out of the blued 
I alte lU allHiiiiinate^ are miiiih wKnit^r ilifTitM'^l into th<; Uuiil^ nf thu ti»<non. If th<^ 
' ntrrounJiti^ lif[nid be iligktl/aoid, under siiuilar oonditiooA anil in tbi^ sarue time ItMW 
albumen mil poaA ihr-jutjh the mcmbraaefl, thui it that liquid bo neutral or alkaline 

^UliTKSlDSJ. 

1. MBCHAXICAL DROPSIES. 

Tbey aiise mostly lliraugli liiudnince to the rBlm*n current of vennu^ 

blocxl or of lynijih, )<iSH oflHii thniiigli active hyiK'tfomia. Ttii'ir Rlai-tiiig- 

I i>OLijt is the WihhI- huA lymiili-cHpillurii's. The hsohjih of wdto.r is in co?:- 

|B2L'KK<:e or tub klkvatki* VHV.»tiVKK, which the incfeuaeil vascular con* 

pHttH exercise upon tho %iis<.-iihir wnlU. 

niroiiylj VENOUS, or mix-hamcal iivpbk^hia (hw p. 183) arise either 
local «?dejnfttat or divijujira of friiigh- st-i-oiix cjivilien, or gcuni-Jil dl'0|>hi«i. 
According to the older \ifw Biinjdn diitiirlmncow of eircuhitioji were buf- 
ficieDt to produce thc-ve efi'ucts; uccording to luore receut iuvesligatitms 
ilioiie must he pi-eseot, at thu saiue time, a pai-»l)')ii)i of the vaso-motor 

^^^Toiu ttii exiwriinent by LfDWin and T'IMs.v, it teauIteJ thnt afttr luodcmte cr>n- 

tmctiuii of ilm YKum wf tlm jJ^j-ni' j>tiriitJitij'i'i-7in'» itioru Iym]»h tluwbd out than while 

the %'eriou.i Ktr^'Am waM iinintjtedpd : thu moniu^a aniijunt«;d iu the oieun, iu Uin^ 

atiiniaU. to rtft p. ct. ot the quantity of lymph whioh, bufor? or aft«r thu li;ratiou, 

HoiffHl from the perfectly free plexus. Were the veiiw c»>iir9:o;j in the ploxujt entirely 

closed. Mi that thf bhiod-tftrvaiii. rutunuiig' froiLi out of tlK- tvsticlo. vraa conductod 

into rOHMll (rlferenl hraiit'li»^ tbi-.ii th<' iiirri'.uu! in livf anirnali* nniimnt^^i in Lliti in^an 

U*^M^n«vi thnt vrhirh e*tf;;i{>('it in th(> nni*oiitrnt-t«d blmwl-Htriiam. XAe^K <!. a.) funud, 

BHlHneriod icul eouiprcaaion of thu oxtcrual jutfiilar ruin, the lymph -fitrcsm in- 

■mmTiO ^tO per c«iit. 

TliKVlKU (t'oinpt. rrntl., ISlJfl, LXIX., No. 25) has again nxperiinentally demon* 
stniT«d the uirrvctmvw of thi; thpory fi>iindf!d on LowKItV nx|ieriiin;iit, i-diiiMiniing 
tbv (iri^.'ia nt uedcintt : tiifstion of the inforicir vena qara within thu thorax is a too 
jrr«»t opcmtiTe procedure ; that of the jiiijular veino (,'ave R ncKalivo rcsultn. 11. 
found ill dor/t. whoMu inferior wiia cava he had liga^ed, tliiit u;dema of the lower 
extr^^utitica upjMiarcd unly wNon thrt iHcliinliu ii. wji.i at the smut' time cut. If thia 
ncrru vtsut '.-ut oil mif siiln, tt'dnran appocLntd only on thai nidti. and nlrcaily n-ithin l-'2 
houfH. whd>' the other fijdf r<niainRd Iroe : one hour »ll«r th« section cwidling muni- 
fwt«d itJw-M about the fcr/i'/" nrh0li* ; one hour InltT tlie »ubout:ineouB eomiectivQ 
tiiuue waii Rli^litly in51trut(.<d ^ VO boure aftcrvrard the whuie limb was eyliudricat 
&nd Mtroiigly inlilLrotwI with wjnim. Iu a do^, wliicli was not killed, the aderoa 
loMtud tbrfw day,i. on the fourth it ilecnaHfcd, ou th« liftli it had diwjppHartd. Seo- 
bnu of till' lii^t liniilinr, and of the tuteml nnrt'UM witJiin tlu.' KpinnI canal, nr of the 
•pi': ' ■■■ ' li.ifc thi' lumbar hwcllinjf. wns not follDwwl by these rexnltH. lience It, 
CO!' it a l-AUAt,V(«lR OK Tin-; VA(«i-M<»'ii)U NKUVKh itliosc from tlie sympft- 

tbt I T:ie er)«r»f of the BciaticJ MI'st iik Addkd TO TDK VKHoi:» STASlft IN 

UHVKH Tf> l-Ai:SII DHOI'HY. 

G01.TZ [Arrk. / tt. ft**. Phjf*., 1871. v., p. 63) found that in b froy deiaiTed of tta 
brvin luid ^piual cord hi* did not Huccecd b,v trauMfn»iau in reitt-ontii; the cdroulation, 
b«}mn«*- the liquid l!owvd out nf tbe dilated vuhcuIuf wall us if Uirouffh a wi^ve ; ihu 
rrinii w- ' ' ' ' ' t ' ■ M iii wor»- covtm] with n frR»: li<niid of u bUnid 

eolrsr V' itionictn bo <^xplainrd by the thinner walK 

ii}' thi :-- ,. ...:_ ,...!_„ !..^ ■-■: ihonerreB, ia t]no«tionabIe. 

a-d«nia from TtmoUH hypcneiuin, mostly with dUatailon of the veina, U vciy 



SST 



OACKKH CfF TfBOnr. 



frfsjiirnt. nn<l ufTects pirticulnrij the rvginn of the Inferior cava, li arisei after 
ooutruuliiiu of tbe vcfuu from cxt'-TuaJ pi-ci»^ure tKOc \t, 181 ; in this wo have alto Um 
cxiihinuUoii iif UiK frciiuciit Inuiors on lliri head of the ni-w-huru), or darit^ the 
foniiuLitrn of victttrice^, frunt ti*aiuv-uhiui)^i) lu the vnnutu walbt <caiioi<j-), fnxn Tuanot 
CiKtffiiln, etc. Th'j oouil ;tiMiiii mcuUimtttl yira rise t») iKhuni, uithcr «' '. ■ '^■ 
fti^si>.t,iuci; nf f.irth'T oftTisos, or iwilv Jtftrr tlieir ajipearaUfSi ; umnncr of 
ahl'-- I'iotUi'l;;, ooiivftk'i.optin'*, hv'lm'Tnia, chji'lly. Mr*uj', t^^iKt'iiilly hn;^- u- , ...... j 

tatnora. net not ouly iu<H'haiiiL'iill^' through ym^Mure. t>tit nlio \^y r\U:ii4tit^ the 
Cdurwi of the tluud by the iiiti-rfKihitiou of a iieound fi^'^tein of rapillottes. 

DunrAtii:^ of KKlurrs L-AviTlK)* uruw Ibm oftou UituUffh iNt&tivu I 
b;'drtM.-j-h> thnm^h ]ihlti))vctju<itt of Ihu afTmireil r(fHiK!l*t. oAcil^tft Lhrmt^h c>i T 

till' trunk, or nf muny IininoV» of ihn portal vpin ; inrcninl h.i'<)riM.'>'|>hnlu-. ihruiij;)! 
ImnorK nl Ihu hase of Iho liraiii, wbiph coinprf^s the oiki twifjttt* fraUni, or tlic 
atrai^hc. <iinii)it>H, rto. Drujiisy of lhf> hi'rubil fuiu alum huit tliin orit;iu 

hi miiiiv of theKi ctvVH the ri|>]Hiai-aiH'<? of 4lnt|wy ih prevtiitwi or dela.vt-'«3 I>.t tlm 
foruiuUuii of willtttural ciiirenta. In the ^reall.v oLstrueit'*! inuutjeo of tho IiIikmI of 
thu |>(>rt<d %<-iu tJiruut^h the liver. (.>/., iu cirrhuesiit of the Itrt-r, tht-rv apiiuant ltr»t vt 
nil II tliliiuUiiiii nf the finrttd vein and of itfl nUlouuuiil umiIm; uff'Twiinl ti dil«tii(i'.>ii 
ot ]inini.'riiUK HiniUl v<.'asrh«, by tnt'niut nf wliioh thi' {Kirlnl U oj" i ^h thi- cniiU 

ayftlam, so th.it tho liloixl of the |iortal rciti. CTftJinvr thu liver, i ■ vana cava. 

liKNKiiM. nrun'HV. frmn vciion!* hyiKsra-min, i» found iu lu.i ij li. . ■: ■h'^ 

hfMirl. I>ff:mvc of the oJvstniotion to thi- ivtiirn of v<'unu,'« hlooil into iJie -i 

the hvjirt. Es|n;oiuJIy tlu olirouic iH_'rl-, inyo- uid eiiducmdittM her.* t:u:> 
aidHrnttuii. giving risu to iu<<ul1ic)4:iii.-y mul xtuiKuus. l>ro|»«y hnn a dtr< ' 
m«utficit*n«y of tliH tticUK|iid vjdv«, whitJi i»r«vi'ii(» thp return of tlie bio 
ri{fht «ide of tb« heart, ami ruiwfqnciitly thn Hi rT nf the blonil into th. ■; 

of th** boily ; aii indirect oni;in in insiiHitVL-ncy of the mitral vaJve, wh; '■ 

to Giv:^or^'<'nn!ats fn thi^ Ici^Sii-r oinMibtion. Mid throiijih Uii; [>uliuiir)H: n 

the ri^Iit xidt! of Mii> henit aud in thn Vfetiis. htill nnint n)d]li.-<:l b* (i 

tiouH of Uio aortic ^'alvuH : diojiKy npiHutr.H ijnitu hite arid iirobably oi..,. ^.. .t*d 

dimiuisUed rw a teryo. 

Artkriai, iivrEit.Eii[A gives rUe to tho tlmgiioHlicalty iaiportaut colt- 
L-'.TEiiAi. <Ei>KMA, wliioli w A roBult of iiitTeiLwd liitonil prtjastu-o iu ilie eft|iU- 
lury vcsiM^lB (see p. If^O). Tlie aumu iMrcun> most oftt-ii ui lb'* nt-itilil-KjrhiJud 
of inttoined [mrts : e.;/., wdiMiia in the vicinity of erywijielns uihI pscuJf*- 
er^KiholiVi ; ludeum uf tht* surface of llii! tniiik and of the i-xtrc!iuiu<*>s, d(ir> 
ii'» tin! pretiiincu of deop jibsc^-iwes ; (lulctna of tlio ptvimco in clutncn'n of 
tlie part: wduiiltt of tiie face and mouth durmir snppumtioii ; u-^lemn 
ffUillidi-n in oiturr}i nn<l uIlnms of the nt-igbUiinug [uirts of the larynx; sub- 
cuUiucous ujilema uf half uf thu thorax during plyural utn^yeuiii. 

The iuduoucc of arttiriul Iiypcnemia upon the flow of Iyiu[»h Is not aa cotuUnt u 
that of hypfmuuin of uut^ori^ttmuat. It dejiondH upon tbo fuot thut lhroiiu;h tho 
dilntr^l artt^'-rinA a hirgor iuid qnicki.*r litood-ciinvnt llow& into ibi< •^Jipillaric*. M'b''U 
Lcnwro, aft«r section of the corrica! "^nn pathetic. ciini|«irL'd the f^oautiiy of lympb 
o'jtainpd with thut provioUHly »ii[Mira:«d. the 8o|>flration in Aome oa;>r>« was found not 
jnoontiidembly ha-it^ned. in others thi« result woh not obtained. l^?dllCf'- " *' ' u 
and tniTea-sfd lyinpb-fonnalixu often appt-ar toyetllcT. SweIIlU(^ of : -i 

frog will follow tUu dippiuj^ of ibt foot into a 8truu|; Bululiou uf uouimou .- — .1-..U- 
VAU£1.). 



Aooording to nivnKi.r.tu.u {I^hrh. it. jatth. G^wtM., 1873, p. 5^3), effmiLimi ia 
Jotomnl hydrooophnliM do not pnK^eed from changeN of tJie eiiendyiOB. tmt from 
struUf hyiwncmia of the DonQol oreular^ed impiUu: of the uhurottl plexoa. 

Wlicn the itETLRH FLOW op LVMPii is iMtEVENTED, 1*3 c-y., by lliromlK'SU 
of thu lyinphaUL-ti, ljy suppumtivu or curciuuutiitutui iii^ltnitiou uf tht^ir 
wall, or of rhu lyinph-glaiidK, <lio|>sip» riu^Iy occur: in part tM.'Cttii8« (if tlie 
fixti-'iiMvu iiuaatotuusii) of thu lyiuph alien at tUfir oin^pi). in )>nrt Ix'mniMMi 
tiKu in tilt] j>ressuro under which thu pAruucbymatoua lii.|mJ.^ exint, is fol* 



MECnARIOAL DROPSI1C9. 



233 



lowftl Ijv {fiiTttiswl rosor|iiioii Tlinm^h tin* lyiii|>lmtu-s, in pftit liecnuse the 
^^eiiiH, (.liu-iu^ aa obiitructiou of tlio Ijuipli-llon', jierlorm tito fuiictiou of tbu 
l^iiiphMtics. 

Anconltntc to StCDlim {ZUrht. f. nil. .Urit . 1S60. X., [i. 32:JV the I.Trnplmtins per- 
^nmi HO net ut rt-AtKi'tii'ii iiltcir fijjnliou of th« a4prln; but, Mrhercrer rvaorpUuii fol- 
InwA. it ie rendt^rud jxiKsihlQ by th« bU>i><Ivf;M«ieli>, which are eiven oft iiU>rv tho itoint 
of litpicure and ext«nd so far dowuwonl tbat they come lu ooatact witli tbe liquid 
me«-*li:tiii cully diffuHud upwnrd. 

Vtd.KM-Vys iJJcrL A-it'i. W*e/tr., IHTO, Xo. ;I0 lu !12) ol»crveil in »ifk nerBOUH, who 
i<)g Acciiunt of Lmumiilic or intlumiitaUtry nfTtK'tiutM wvDj oonipclb-d for vr«olc8 or 
■Bntbn to huld n lonrnr f>xtrfniitT irainnvaVily in im oxirndi'd potiilinii, frtxitumt 
|^Rlt« or chronic hydrartJiun unmodiatoty after thi; flmt nttcmpt at motion, 

A i-*K'j*i, dropey i*. (iuiw> rarely dependent upon tbf lympbiitica alone. In n num- 
ber of ejwM ftttrDnited to this reUtion. there in fonud a MinultouuoiLR obatructiou of 
tlie VMinits uiriitdiitiou. nr a i:)mti};(i in ihu lyiiiph-^lHiKlM, im Ih it jtfinri pri)b;tble fTOiti 
thti nt-nr rwlaliim of xhn «miw :iiid greal lymphittitw on tin* flnxor aide of this extrt-nii- 
lic* (iiigniiial rt'^aou. uxillnr^- spau«. cte.V Otbor cji>es nrt. without safe luintoiniool 
gTonndfl. refcrreil to contraction or iiillnmumtion of the ]yinphatic<i: thiid clephnn* 
UoMis. jJdegtwf^a nlbn tLiiem, cpidtriuic jmr^AitU), iiidiiriition of tlio roniit^utivt- tijwiio 
bi thti uew-bom. Ou the rontmry, tlio lym phntiiw, f;H|i«>irinUy l)i« n;tro-pi'ritimcal 
•n<l iiigninal, nre iu laoKt cumx of nylema found rBiiiurknbly dilated and flllod to 
di«t«nt)on with clear liquid : this d«je-n not, however, bo much demoiislrate their 
iaofff-a.i<?d aotivity. na the op|x>aite (oou»e(|ueuctis of diauuixhed elo^tiuity and ton- 
icity of their own wulUi, of diniinieiht'd muM:uUur luoveiucDt in the ux.trciuitiett, 
ru^piruiory orgou*. heart). 

EM.iiUiibUlvNr OK TMK OITIC I'AI'IU.A. ophtlialmoK^eolly ruid cirournittantiallj, 
aliM) cimicniiy, iTn{>ortant, hiui itx origin moitt freipient^y in nii inor<'a.ied onllectioii of 
fliUil in the BiibVH^nal ^pncei, i.r., in tlic »piioi.>f( opetun^f directly into tho nmoh* 
ijotvlal wpiiw of till] brain beiweeu the out*r and inner optic Khoatliv. (.Experiniootttl 
autl cliuical iuvei^ti{;ationi4 of GKAKKB. M \\z ami othereL i 

Only in very r-ire ciwan of gcnt^mi drojMsy wim it dt*i«!ndpnt upon a cliwnre of the 
thonuni- dui?t \Viii)*iti:i(0, Si ukkii. Fit, NAsnt: uhxarvcd it in man. Vincuitw in u 
Duw-lHjm oalf. lliOitT. dropsy in uarr-nvmtr or L-losuro of tho thonitic duct Dot 
hifrequeiitly i* cnlir«ly ulisciit (Vniciiow. OritJl^ZKIt. and oUiirrht. becaioie sLill 

Kpr inow^ulatiuiu of ihv Iyiiiptuitic4> >\ith the blood-KtrL-uui arc pii:»c*ut. 
L)iseASEs OP TUK KRiLouB UEMBRAXF.s, eR|MH;iatl_v thickening of tliein after 
Uilliu,nuijtiifii, iul>er<-iil(>six, ciiiioer, give riM- witli ciutijuii'Mlivr rartuicsa to 
di'0|jsy of thrtso membra iio^-t, vol ofleiicst in the tunU-a pnffhutliti and ia tho 
kaofvjoint, hrnjisir^a uf this kind pusti by imdcteriiiiuod limits into in- 
BUiutiuus with bcrutM vxiidutiuu. 



ho fixplaiinHon of tbmo dropoics becomM ca^ty from our prenent knowlMlKO 
pceniini; the Ktruutuni of surouH nieii)bmni>«. And ynt dctaib'd iiiVdMig-atirms «ro 
[ vfUiUt^;. TUtwf dropsit'B ocrnir cither tu nuch a munuer tliot b<-'-Hidc the di«- 
k1 K*rouB meinbrikUOH the riinaiudtr aie normal |hy<lrocclo. ftj/Umr^iAniuM 
nitui chroriifM, p.Tltxiucal tubtirctUoxiit. [Xtrit^pmiai conucrj, or so that the other 
riiiH caviticv cuauiin mm-ii leu water (,mo«& frequent in higher gradMi of hydro- 
pconlinni). 

fn droimea ariajng fi-oru viacASB op the olakds, ns well of the liver, 
ben, titid kitlTif'ys, a» of many lytn|ih-^i»LiitlH, (hero im luUltnl tu tin- jmro 
chaiiiual uoiidiliou of vafccular couti-acUmi after a longiT time tho dy«- 

it' — liydneniitt. The nut-hiuiicKl fofce coiisL-sts in contvaction of the 

biltarv vvHKtdH, biinill arU'rir-.s niid Vfiim. I'liiK im tleju'ndfut uhuve ui3 

till dHgcii.?rnlion uf the bli^Kli'i-s-sels, csj-Hcially tho htrdaceuua, u» wt-Il as 

[>» liy|K'rln»iihy uiitl cicatrit-iiil contnulicMi of the conneclive-titisue ]>or* 

tiiin of thew; gliLudM with sitmiltuuiMjuK )itru|iby of the vessels and glmidu- 

cIcnientM (gmnuUr liver, gnmuUr kithievH). 

)uoi*6ii:& AND tiCbuiA EX VACUO oucur aa uAloiiia of (Jie pia lualer of tbo 




934 



OAcmmnr nnopsrEB. 



brain, nnil ilro|>Ky of tlio cei^tbnil veiitriclefl in gemoi-nl and parlUl atrop^j- 
of tim bruhi, :u» (|iiick ro-iMl lection uf fluid iu a soruuit cavity, wbich wus 
dropMical, uftur evucualion of (.iiut lluitl, as hydropericardiniu iii a diiuiuu- 
tiuu of lliu uize uf one ur uf butb luug«. 

2. CAOHBCTIC DHOPRIES. 

These arise iu coNSEtit'BNL'E or A caohexu, liydniciuia, «.4., of a di»t'oaw> 
of tlie albuminous, and incrcaRP of tbo wati-ry i^nntonta of tlie blood. Jii 
r«iility, tbny ootnir bnt mrely by ibemselveH, wbilst in oiost Citscs eitlicr 
simnIt4iii('onsly and fnjm like caiiw a niwluuufal forec is pn-sirnl, or wliilit 
the latU.-!' aiiaes in cousciiuencc of the cucht-xia aud ia the special cauae i)f 
the serous eeoretiuii. (8ee Uydra-inia.) 

The [)uret»t caeUectic di-up-jiea are those, whicli, coulinuing for a long 
tiniCf originate in conditions connected with iNsi.i-'FiriKXT No|TiiiftiiMe.NT 
aud digestiun, or with large httniorrlmgeti, or otliui* lus^^s in other ways of 
albuiuiuouu maltcni. 

Dmpsy in oodKoiinonce oj TXsrPFif lENT SotmiBlTMENT (immition^ bt very raw. 
F«rhnf)fi to this cittmn ore dnn tiicinc oiUKft, vrbicb iti yeAvn at fantiiie »p|M-Ar e|<i> 
demioally, f.g., iu 1771 in Eiobitfeld (AkaNV Viwiiow o^iwrv*^ th» (lro[wy neither 
in the e])itl<!mio of I'ppcr Siltyt^ia, nor daring t^be fnmm« in Spoenftit- In the 
bodies of itiulviiluulti who have died of cuiie^r of ibe ccsoitbaifiii or stomach with 
oonMidt-rublo Mt<'tiotu)<, for the most jiart uu ixtluiua biu beuu fouucL at the tnuat rui/ 
litUe of the ankles, oiarked oulj Id uouipUcRtiena. 

In (■0>rVAI,Rs<?ESrE, espeoially after acute diHeuRes of long duratinn, 
<]edoina uf the lower extn^niiiii-?. jipprai-s very oftt'u, if at the Rauic tiiue the. 
niuritive .su{»|tly i:; insutheient, or. if during a full tjupply nieclituiical forocii, 
A8 sitting nn<l stjiiiding, n^Mtt Ot^/'lmpa (fravxtatirux). 

Il.EMoainiMtBM (if ail tittMtica, if they are ut onee profuse, and still moiv 
if they often ivcur in greater or le«s quantity, are not raruly tMuiws of 
dropay. 

Lo>'G coNTtytnyo siifPfRATiON of the akin aud of the bones, luucoas 
dittebiirgfit fniin tlip nose, intftititie, genitaU, xuppuratinns of hiiupli^ 
dysenteric, chronically syphilitic, tubereiiliiUH aud caucorous nature, e^po- 
cially uf the mucous membrnmw, more rarely in serous membranes (sup- 
purative exuthiiions of the pleura, etc.), and in |Kireiicliyniatji, ai-e likewiMi 
not infretpieut cauHesof drcipHv, — frequent, liowfviir, wilb »itiiu!t)itie<ru»fiittT 
deg«iieniti'.iii of the veSM-ls of ihv lar^- plaiuia. 

Alucmimuia i& one of the uiost ire«ptent cauncs of dro]i«y. Its gcnrrnl 
causes are not yet known : it c»n havf its origin either in t»itcli chatig<.'--8 of 
the tneiidiriuies between (he blood iintl the nrine, tJiat they permit tlie 
albuiuen of the bl<K>d to pass ovrr into the urine (iuerctaaod t«u:aiuu iu the 
arterial, or engnrgement in the venous sy.st4<ni} ; or it has itJt origin iu 
change's iu the pio|x^rty of diffuKion of ibf albumen of the blood. \h-<'\ -\ 
in albuniinnna i» n eunnivpu'nee of the thinning <>f the bloo«l-»erum, ulii<-ii 
again ia dependent partly upon tliu low uf ollmuien, {Hirily u|K>n the accu- 
mulation of water in the blood. 



The kidne.T»i bave a douhle (iinctii^n : tbcy t*«|t«rate the fi|t"'*^'" ' '- -^ ''i"* 

nrilM from \\\c )>lf>rkl, nnd lli«*y nrw the p'gulntors of llip. iv 

bluod. Throuyb diHCnrtianw of the firht nriKei urjpinin. lliK'i! ' 

(Inipsy. The bitter U uiet witb inobt regularly tiitd larp'ly iu ihu (•■■(■ouil »■■. 

BrigbtV diHcaHC, IcM often. aikO for the ]DO!>t pnrt iu Xev^-i tlr^iee. in p'uoular \ 

In the fiirmnr the ipmntity of iilbumim may reach to ihroc percent and more. »!"■ Ii 

doilj oniounts to twenty grammea and ovur- in the bettor it in very much Iuml Tbu 



ACUTE DROl^IES. 



235 



albaininnria in ^nnnlnr kiilnri,- lie in the very higb liloml-jirfftoiirB: 
animal tnembrnuefi, which under rt mniicrnti; prossnrc of Itquii^ arc imi>criuv;il)]« to 
albumen, eU;., let. siikiU i|<iiitniticH of it iHt>5. Ihnni^'li uuiIit iucn:uh« nt Ibe crt-Mture 
of filtZBtiun. lit tliv htK'iiftd r>l;>);i' nf HriiflitV diffiiH'' iLlUiiiiitiiiriii ih (trobulily il«- 
pendcnt tipim tbe jiillaiiiiiiatory chani^es of tho urluiferous tubukH. (Bartllk. ia 
VoLKMAKN'it ATiVi. Vvrtr.t l&Il, Ho. So.) 



To ihe fa4-ltet'tic Uix)|iKieK belong also those of W-OHButus and conditions 
reseinljlitig it, which liitt^-r ore sffomlury U* tunny chronic iitnl tioino ucute 
dineitses; bRttiili^s thosi; in malarlai, rAiiiKxrA; m wull a» Hnnlly those 
after cliroiiic PoisoNixr; wiili Ht6«.-uic, utc 

1>R0P9IKS paojl iTSK.vow.v uAi'SEa ai<e found after t^tking eoli], afttu' the 
quick <H»uipiteHniuce of ciitJHitx»nH enifiliona (ucute and chronic), nAcr quick 
hf^tliiig iif ciitaniHiiiH nh:erH, in Kt)|i|ti'CHsitjn of nieustrvnitiou. Muuy of 
theisc dropsies are of congCHtive origin. 

In ft nomV-flT tif tbew canes tbere exist perhaps the consia of (lrf)pK,r abnrc'incn- 
ttODcri, and the lntT<tr bven from the same vauiieM, f.g., quick bi-dlin^ uf L-ulAiietma 
alccra. iwippr?«*i'm of miiLstruation, and luuinorrboldh (i>rimnry di«i«y). At other 
timcH thi? dmitHV IK i,lf'|K!i)d^iit nixiii tbft kidnryu, irkitHt thr rjiubcfl of disease. «.j^., 
the toiU<ti/ium of wurlttt-f vrer, iu.-tH nut only upon the skin and throat, but aLh upon 
tlie kidnejs. 

ftTot more certainly known is the pHthogenons of the not infi-oqnenlly 
t* dropaies, a|t]ieAring especially in tropical conntiics (^(vealled athm- 
PUCRic bBoi-sY). I'lohHbly these also an- for the most jmitt^f congestive 
origin, ami aiv con»tM|iienceH uf direct or rr'Ucx nervuui* influence, pt-rh;i]>ft 
sotuetiiui's uUo imuiediate consoqucncea of iu-rc»toil culaiiouun function. 

t^nrdin^ to DK Kaen almost the whole army oC Churlui V., in the tiypwHtlftn 
iwt TiiTiii, b*rcan)e dnipHical throufrh C'lld drink iifter long abirtincnco, DDring 
more weent cinii[iiiigTiii of the rrcnfjh in Algiers. tT<)emn not infrvfiueitily 
!atr<?d Middeidr. nii«tly in tbp fao*. neck. fore-ftrm!«. hands I*'g" and teat, wbicb 
in ■Dbscfiuoot ixiiitinimuw wanatr wo;iLh(:r by d«Krcej» diKapiK-ari^d of ii-'M'lf. Alw ia 
the iifttivcM of Africa Miint-tiitiiH Hiidib:ii luid very Uur[f«! unlcrua of the iK*ruttiia arises. 
If Uitfy an* nvextakfrn by the rain iliiriiit; work. 

Ai other timrtt bb)<xl-cbung«9 are t<iniiil(-[uicuu«ily present : in chlorofiie acute ixdema 
of tbOM- |Nirt« which ore cxpoftud to tho air; u-'domu in acnrbutiui; oedema ui snake- 
bite; (L<deum in the pregiuuJl aX*Ai vritLout lUbuiuinurin. 

In our own rugbni alxo, there ia ob>crvcd. in nmal diseases already prrneut. on 
influence of tin: nir ii|)on the origin of drop^it^al nwf^lling: f.y., a'deina of tbu face 
in Bright'H diwsii**, which ia pitjicwwd to the air at the usnnl or coMcr leu])H:n>ture ; 
likewJM> ip<lemn nf th*; fnoe, of the oyolidh, of tho neck and of thu upptT \tt\Tl of 
the breast id tho cblorotic from like causes, with for tbe most, part quick diHappear- 

Uioe ((KltKUA FtlflAX). 

Tbe fnunsM of th« follnwingdropiiies ore likewiM iinknown : hjftlrojmttjmmevs ac 
hytffiruM ; hyflr"]t* pimUj/lirut (ri^bimn in th<f pnralywd half of Iha body); A^ttrt/jm 
irritittitua, am a uonRr>ipir!mv of slight irritalian« nf the nkin, vhiob at othur times 
|*roduoe oidy partial rednuw anil inBItration, in individnals with irriuible Hkin, 

Dropigr *>l ihe face win wKin by niywlf In a cum.' of a tdiihl fnur ynam old after 
twf b ."■ • >-m"i< (Miwdent of morphiii*': it dixuppL-arwl uflcriiboiit twt-lve honra. For 
di>> 'T it auain apiM-arrd Hft'>r tbf Imlf da<4e and had an eqtinl durattcm. 

1 'if thf iMlenia of tbt; faco and exTreinitien oocurriny alniosL L-oiutantly 

in exteui-ivr iNPW-rioN wrru tbt* hik.k, lii!, acconliup to t'o^UEnc^. in the destruc- 
tion of tlie on|Hllari«e of the uiu»K.>lca in tbu part ulTfrU-il by thr- irnndrring trichinsr 
and tbe li*TOf sturrouuding them; tb« u'rbiina disapjwant with llitr i^ntnblirihnient of 
tJiC! ii»'w i2iiHiI:iry rn;t.-work, A«:<>rdiugtoKl^in i OrWr. J.i/irb,. tSUtJ,!. ii. "i. U , p. Ott), 
r»«il«;nin :■■ ' -•■^- - iiin in not H o>ti"0'|tiPn<'ft of collateral hyprraniiia, but (Icpciiduut 
rithcr r|' ' ihromboKin of the floor vejwrls. or upon tln^ fiiot tbnt the tricbiiin; 

make n- lymph ubunneU for their wmulf^niig. Uosides abto ujvou the fact 

that the moscnJar oo-operatlon In the motion of tho lymph is desiroyud by the 




iclilnouit {^rvtioD of llie mnsolw directly at one time, when in oons«qoezioe of Cb« 
Irribitiun uf tlio tissuea iranaadaUon Is lucna&ed. 



SYMKrUMS OP DkOPSY. 

SVMIIOMS Of DHOrsU'AL IKFILTRATIOX. TliO ii!d4<IilutoUH pUtU are «1 
laru>*(1, i»iik'[-, iiiuru or less ti-BUsliii'ent, mostly cJouj^liy tu tlifi toucb, rnrcly 
baitlei'. TLt9 Kkiii, or uiucuiih iiieiiibnuit'i ur b<?ron& lui/iiibrauo covorin^ tb>!iii 
it> suiuuth, witliniit wriuklpH, iinti'vaHcMlar, tliitiiir-il. TLo |ir<>|H?r warmih 
of tilt? pnrts is, in con&ofi neiice of the i-cUrJetl eii-culHtiuii uf tliv hkin, 
diiiiiuistied. This [mrlit pit undrr pi-esH»re by the liii^xr, ii* well ua from 
lires^iui} of rttliur kimbi, v-if., by tiw L'lulliiti;^;, jitirls of bed-clntiies, elc^ the 
usiml level i»f the KiirfuA* \wm)i t*IowIy n^guiiitfil, 

III g(>nrral imli:inu t.lH) viu'iiius |»m'U uf the IkhIv nre ir<teitintous alTrnyi 
in (liirci-ont ilirgrct'if. TIio uidiMua iill'ecta leuitt, iu the usiwl iJOfitioii oii tlto 
back, tlio heA(l und tlio upper uiid iintviior lialvMt of tin* trunk j nuHia 
drcidutlly, tliu upper extrcniiLii's; it ia luobt duveloped ill th«! lu^^rr |xirltod 
of the alMlcinien, in the jj^-nitnU, nnd lower (txtnuiiities. In htcoX (with the 
exccptioD of Ihe ai't^'rlul foiiii) as vrA\ as iu ^feiioral (fdtMiiu. the iF*ieui(itou$ 
liiiuid siiiks to iht; lowest pHrtn of the body : iu sitting, Liilo Uiu \v^\ iu 
l>'>!>)?i nccoitling to thi^ |inHitiiiu tin \\w h:u'k or Kidt*. 

All th(*^ ftytnpUtius uru iiitx'iisifiCMl in pr-t^portion to the length of time 
tlii'y nxiKt ; there upjMrur uIko distui'lmnci's in tlit> uui.riliim of tlit' piuls, as 
diHrrenae of n lijiotti' t.i.iMtie, diiniuntinii (if thi> ghiiid>ei.*IU, InrnTAtidn of thn 
vfssi'l^ juid rvi^n of thu skiu (fuUu cicaLricui of the ahdotucn lUid upper 
piirt of thi; ihigli). 

In (I'llenia, still other dtstnrhunci* have thi-ir oiigin, u-hicb ur^ in part 
gonerul, in ptirt ntul especiully loi-ul. Tht* lult^T uru : fefliii'*H of teiiKioti, o\ 
wi'i);ht, which ant intense in proportion to tlie lU'iiteiicKH of thi' UHlrnu, 
dt'licieut tiUppleii'Mi uf the iiliri*onjidiiig ti^itUL'S, uiid to the dttxHiglh and wii' 
siiivunenft of the iudividutd; fi..t<Uui; of weakuewH in the iiiUM:lr», e8jH.'ciiiliy 
of tliu r-ximmiliBK, iliminiMliMd rtjiilnu'tion of titripfd ami Hiiiooth iiniKclen| 
IpHM^ucd tixeivtioii of tlie glaiidx of the skin aiJil ihucour nifinbi-»iii>A, iu 
conseiuence of pressmv, anivnjiaf etc., (dryne.HK uf the skin and iniiciitM 
nienihrHnes); narrowing of Uie ojteningit on the Hni'ru-*<', and of the auuil«: 
uf thu mouth, of th« opfuinj; of the nyeliclR, of tlie Utrniinntion of tho 
uretlira and Viigiiiu, of the tliroat, entrance to th<> larynx, glottis. BtundM, 
thera arine HiKtiirlmnces of nutrition in comtiH^ueiice of ooinpresaion, tmU- 
bitioii, luneeruiit-'n (in the nt^i^hborhotKl of the cerehml ventrielco^). 
Soinetinii-h it lendi* to watery trtruxion through the jiunn of thi- Hkin, ah*o 
to Imvration of the tissutiH, Mjieeially of the itkiu of tJie lower exLreuiitift, 
aoRiL'tiiues after prcvioutt formation of hlibtvra with coutjequeot triokJitij; 
out of water; n«>rly with resulting gttugrene. 

The Hyiiipioiiiti of uHlc-nta of the pareneUyniata (hrNin, f^IfunU), a^t well *s 
tlioso of puluuinary ledenia, consist mostly in a very (»1i},!ht iiicrt>ttiw of Uieir 
size, bt*eaUMo titia ia usually preventnl by t]ia auiTounding ^Iructun-* 
(cranium, tsipHule of thu tivAr, ul,o.}, ohietly in iliuiinished or alt^igi'tlir^r 
auppresM-il funetioiis. 

The sviiiTouK OK KKKE DR0P8V are: increoao in tJio capacity of the 
ciLvitiiw ill proportion to the yielding of their walU (/itfiira rMt/innJii, 
abdomen, jiiinl«) ; a dull ur empty prreuHnion 8onuil, at lirtit iu the di!|wnd- 
«nfc iMirta, with chants in llie toue corix-sponding with the poMicion of tbo 
pei-aOD afl'eot<'«l ; riuetuation in cavitien whoso waIIh are supple aiid UtU« 
itiHlunded ; eiiLX-iL^siou uf cavities coutainiug at the Kanio time free or cen- 
Hiicd air; diniinihliMl, or absent nnseultMiory symptoms (huign, heart); 



Co 
1 



STSTPTOMs AND COCRSK OF DEi>P8Y. 



£37 



OTHmwiituf^B lUe poainoii of tho jwtiont pxerts a great iiiflufinpp over llie 
^ivuter ttihtiiictueNs of tlieao iiyrn|)toiit»; clmn<;e» in poititinu of tUv or^aiift 
111 the ciivities inclosing ur buniering upon tln-tii (lungs, iiit^'stines, heart, in 
<ir<»|>sy "f ihwir [n-oiM^r caMties) ; di»tlix*»tioiiM of ilm «liwj)limj;ni, liver, rik) 
»j»lc*'ii, of thtt |ii-;lvic coiiten(j), of tli** »lnloniiit:il tnul t.lii>cfti-ic wnlls, of the 
xn(*diH><tiim, i>eneanlium, and heiirt, of the cranial iircb. Finallj, fnni|iit*s- 
siot) <»f Ihi^se tirgJtitK, iKni flu* rofiiiHiiig rJiniiiiiKln.'d or i^nt-irt-Iy dt'slivyed 
cttj>ai.'ity of t^xjiiinsiitii : luiigH, ln'Hi't, gwal t)I>[lomitiul glnndh, tuviiii, ti^stt- 
cles; or diroi]ii>h(>l cttnti-actilily : litNirt, alKloniiimi, and intei-costAl mudr 
cles; tJicDce nnicmia and even iitro|<hjr. 

Bi*flides, tltif KvinptoiiiH of frue dropny include tltotw from functional dis- 
tiirbancc*!; of tlir aflf'ct^-d organn, caiisr^d liy tlieir diuiinialK'd incliility ; by 
cbniigUM of place, ooni|>rGfisian with conM^outlvo au;emia and atrojihy. The 
functions of the organs are in general rendei-eil difficult : dvRpriira, diges- 
tive trouhUii, stufMifucLion, and paralvhig, eto.., are pioihux'd. 

If dittjvy oppmts to firtal life, there arise atlU greAber tmablea. «.ff^ in iDternal 
hyArocui^udiu ; if it sete iu during the ftmt iwriod of IwtBl Ufa, hemicepholia and 
■neaocphatia . 

In GEXERAL PKOP8V tliBiT 18 anothor series of symptoms^ which are 
depmdtoit upim the rauaea of di-opsy or upon itt* con^fpietices. The »*x(rn'- 
tiona arc tliniinished : the Kkin is dry, inflt^-xible, Houietiiixia si-^tty; the 
mucous membranes are mostly dry, their siK:i'etion t*!imcioiis ; tht- urine in 
acarc, dark, muddy, the Htt>olB conHli[uit*id and JiaKl. Nut infrfqnctiiry 
sonic wci-f^tion?* arc, <hiring thrr whole duration of dropsv, or from tiiiu? to 
time, very abundant : lUarrhn'i^s, <f.//., arc met with, cvm where tborc is no 
atf*etion of the iid**stim's present ; or more abundant clearer urine (in dia- 
bete* aibi*mmmuH)\ or abitiuhint aputn (bronchitis). 

KxtravMSHtiouH, nnd mixturcn uf tliiNW with accuniulAiions nf wnter, are 
aomctimcfl found, particularly in primary, rai-ely in aecundiiry hUiod-changea 
having their oi-igin in dropsy, in wdema as wplj us in free dropsy. 

Tld? bI(Ki<l-chaugpa in dropfty ai-c very diir(>r<?nt, acconling iik they are 
primary or (tecoiidary. Sometimca there appt'ars in traiiKUdatcs, which are 
cs]>cciatly rich in water and aalta, an inspiaaation of thf< blnud with a ]hv- 
poiidorance of solid constituents. 



COVRSE A3n> TERMtXATtONB OF UROPST. 

AV'hen the canRPS of ilrojmy peraist, the farther transudation of senun 
goc!4 on, until lh<» lonaion of the (cdeniatoim or dropsical parts bna bccutne 
as great aa the mean tMision of the art^'rial nystem. 

llie dropsicjil lltiid ix'maina the same, whci-e iti quantity neither 
diuiininbea nor increaaea, in continually changing relation to the blood- 
resaels and lymphatici, T.r., eleuuMitK aiv always being taken up into the 
circulation, and theae are again abstmct^d in less, equul, or greater quan- 
tity. In this c«w, not only the circulation ia never entirely arrostcti in 
the (wirts alwiit tht* water, but thun.' is also an absence of the graver di»- 
turbaucca of wutritioii in tlw» opilematou.s tissues. In many casca there 
occurs a hN^K-rtroiihy of the skin, connective tisauc, etc., os|>ccially in the 
lower extremities (elcjthaiUia*i* Arnl/um). 

According; to Vinrnow, tlm long pfinnnt^ncp of the Hfiniri In drnp**}" of cjivities is 
not ditHeult to coiiweivt, «e|w;vittlly If tbe wnlln of the oavitiea are very lieuBC and thiok, 
since tt, by it* preMoro upon Ui« walls, auit render rcaoiptiou dtffioall, and since 



TLTtMIXATIOa OF DUOPBT. 

lnTC nften very ftdnooed products of (leco:atKMiiii>ii, g.f,i ohoteitearuie. are fouDtl la 
Ipvat quantities. 

DroiiHj is either acite, t.r., it luAtA only it f^w lioiiiti, (lny«, or weeks, 
wictua wliicli it iJisniipi-Hi-a, or i-ml» with lioHtli ; or it is cilKOVlo, witl» a 
dnrutioii of muutbs iiud yeartt^ unit, if geueral^ iiKually Iulb u TuUI tcrmiDs- 
tiou. 

In ftomo coses dropsy in tntrbmittent, partioalorlj thoAe forms of it deiwudRnt 
dlMia oon^jTCKLivu bypt-'noiuio, ns wt>li ua ibuau wliioh are TicitriouH : we bave M>cn «uuh s 
dro]icj iu the kiiiH<-joint, wliiuU had laHl^d a ytmx, nnil which rctnrtid vverv 10 (Iajv, 
nnd after '2 nr :t cIiivh nipiiti diupiMiarcil. Similar comm have lityiii CdtnmiiiiiuAted by 
LrtKWl^STItAI. and lllirSft. 

The HivLiinn of timpstes into umte and chroDio is practically Important, ytaxij 
Llra|isii>8 nt Mli^hi. <;rade hnve thfi HhorlCfiC diir^ition. like the pafflnew of tbo face 
during iiL'voro uifAckx of ctiii^bJng, r.g.. in whnnpitig-cajatclL Tha drvimon into aotiTe 
OLd passive, into Ktbenlc Bud (L"t.lienic driiiiiics. is itf little pnu-ticnl importaDce and 
WftntiuB in princiiile. The enrlttir diatiuctioii boCwwn hy<irrqi9 otiidns g. injt>trttm'i- 
toriw, Biid A. fn'ffirtuM t. grronaa a. loriiuluv ^to irhich uiost dropsies beluuff) now 
sgaln rnceiveo uoiisiiloraUon. 

Dropsies eud in i-ecovery or in dpath. 

Tlie TKHMiNATius IN KEcovKiiv, ifiuoral of the watery liquid, takes 
place: rarely nt once through pkoforatius of thk walls of tue cavity 
exteriorly \\i\. HKcil(-fF<, ^■.'/., ti)n)iii,'li the navel, in Kpinn bilida), or inlo Uie 
nurromidini; connective ti*.sne willi conHccntive resitrption, or throngh per- 
foration of the a'di-malnus skin, ami cvncmition of tlio liigiiid ; sometimea 
thi-oiij^h nunsTJSo of the skin nt many points, un*! gradiml trickling off ol 
the H<|uid ; moat frequently, comparatively, thi-on^jU (quicker or slower re- 
Borpiinn. 

The recovery is either geauino and permanent; or, the dropi^ after 
sliiirler fir longer time returns; or, with es[>ecially rjuick resorptjun nf Uio 
liquiil, a*dt*ma <>f tntermil orgiins (hrain, luni^) up{>ear«; or, from unknown 
cautivH, de4tth ensues. SiHiutaiieotis (piick ilrcir-juie of tlie droptty is con* 
Kidered nn unfHVorable omen, beciLUse the water may aceuuiulut' in more 
important psirt^. Usually, however, anastirca nppeni's Icsii KoinotihteR be- 
fore death on account nf the coltaprte of the ngony, because intho AacddnetiS 
of the tisHiiea it Hink.s into the d«'e[ipr pnrts. 

While general ohronio dropfdeo hare on unfavorable pro^^nosis, there are many local 
onea. c..?., of the lower eirtreinitic^, either without iuOuenoe on the health, eren foe 
many }catA. or which permit of jmlliuuve, ransly of radical hulp. 

The TEKaiNATiON OF DROPSY Df DEATH followg almoet uniformly in all 
general ehnmic dropsies. It in becnnflc the punrsv aH'octs one or more 
of tlie riRCiANS essks'TIAL to life (sudden death in oedeniA of the brain; 
quick death in pnlmiinary u^denin, iu ledema of the glottifi : slowor d«aUi« 
in the same conditions, in hydi-itthoriix, hydroperiivtrdium). Or, it ia 
dejiendeut upon a rA<,^irEsiA, wliicli either has the Kumc c»nso as ibe 
dropsy (i-etiul and hopatin diseases, etc.), nr is a consequence of the dm|wy : 
hydrothorax, a.scitcB, obstmcted resorption of the laeteals and rixtts of tiie 
portal vein, etc, ; erysipelas, siipinnative innammalion, and gnngrene of 
dnipsieiii |»irts ; infisninmtiorifl of intemiU f»rgana, etc. Or it appeara aflct 
ortiBATioN's, piirtiotUftrly pnncturea arid qviick evacuation of the cavities, 
either withmit deinonBtrable cause, or in consequence of exteusive lueutor* 
rlu^- into the cavities, etc 



I 




PSEnrAro!-is. 



2Z0 



APPENDIX. 
ACCUMUtATlOS OF .UB, OH PNEUMATOSIS. 

Oonwlt Demakquat, TcniiKA einer mrd. Pneumat., transL from the French by 
Be^hor, 18(17. Ahio the wotkj on |>atholc>g-icaI onatom/, aud od geuera] pathutu^. 

Parhologifnl Af>tT>Hfi.ATioss op aik ocrwr in eavides arnl clmnnols wliich 
cmituiii air iiornmDy, hh w*-!! hr in thosr in wlucli, uutler lutruiAl couditioiiR, 
air is not found. Tissiips and organs verv i-arely contmin wr, which in the 
aornial &tutc> tttv free from it. 



Aeenmalaiionn of air in different -ptirUi of the hwly hav« for tho mopt part. K]>ccial 
natnr.x : th»t uf the plntirn in (-ailed {inRnmiichomx. thnt in tlie jiorjcnrdiiiiii, piimtinu- 
pcrimnlinni. etc. ; that iu the oav.iy of the Ktomnch mill iut^^Rtinon. m<'t*"ni^iu or 
tyiopanite*. Jii that of the utorus, ph^itcmt'tra ; ihat iu tho vcBicles of the lung*, pul- 
ninnary euiphyat'tiia ; that in ciiiiiiontive rwaac, omphynt-ma ur tmuraatic emphy- 
ttoiiin ; that in thf> interstitial or HuhplPtirul pulinriitary ttn'iae, intenititJAL or anb- 
pk-ural vmph.rwma ; that iu the blood, pnetiniattiaMUia. 

T. Abnonnal ftcctimiilfltions of air inlocaltticH which normally roNTAt» 
Ain admit of no general consuirrntion. To thrs« btdong; iiierrase of jjaws 
witlitn til'' rttoniach and int4*8tiiial cnniil, espcciitlly of die lar^^e int<-stinea 
fniHtenriMii or tyiojinniteM), incrcaao of t)in i|UHntity uf air in the |iiihiii>rinry 
v^iclt>M, wjlh rnlui-j{i>m^nt of thrm aad alntjihy of thuir iMirtition-wuIJa 
|(ve^i(;^llR^■ pulmonary i.'ni[iliy«('mu). 

II. ,Accnninl:itiuiis of (iir in Iiwalitias (cjivitieaand pftreneliymata], wliich 
IN THB NORMAL HTATB ARE WITHOL'T Am, havo (hetr ORIUIiT ill variouB 
wayn. 

u. The air is from without, or prom parts op ths organism waicn 
cvtNTAiN AIK, and PKxm'itATKs into the pai'U uifcuteU. It enturit either into 
oivitina or into {ntrenchyniHtu, 

'llw entrance of air into oavitie<i occnrs : from vrithoui into tho pleura, 
pt^riconiMini, jwricuitliiini, into tho vagina, into the ntcriia in a fini;r]«Tal 
Btuti', into cysts througli acciiUMitiil or opcrativn wounds; entrance of air 
into the* veint, thwiu'c into the right cavitioH of the heart ami into thn jml* 
mtjiiary capillaries hy woiinda and o[M>rationw, ospwiially in frht^ m-ck and 
QppMr oxlreinities; the entrance of air from thn nir-passagn.s or hmgs into 
thf plfiiral ca^-itii^s in wonnds of both; in perforation of nicphyseniutonB, 
t\il>or(mloiiR, j^angrciiona parts of these organs; the entrance of air from the 
gt'iiiiarh and inti-atinul eanni, rart^ly from Uiu lungs, ntenia, et«., into the 
p<'ritoooal cavity. 

In gynteoology, gnrrfiUtia ruhm, no-called, the ponotmtion of air into the va^na 
and ita uaixy RiKape, plays a rule. 

Of those caace in which emphysema affcet« the PARENcm-MA, emphy- 
sema of the subcutaneous cellular tiwme is worthy of notice. This arisea ; 
trannudieally through th»i inU'ntinnal blowing in of air, through |ieni!tnit- 
ing wounds of tho brca<tt, fractnri! of the ribs, wounds of the luryngo-lruelifal 
IhIk!, throngh componnd frnclnrea of the ex t remit ion, throngb fnn'tnretf in 
ihe nasal, frontal, miLxillary and ina>itinii»l rpgiona; not tranmatically : in 
con&equenco of violent niovcnictit«, long-eontin