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fore laid down, will, it is believed, point to and justify the following conclusions:
First-That from the shock of the accident to the patient, nutrition in his system was very nearly, if not wholly arrrested.
Second—That oxidation, waste, or destructive metamorphosis, if reaction had been established, was largely increased.
What are called stimulants, as alcohol and malt liquors, opium, &c., simply serve to hold this waste in partial check, while they are used. They do not add anything to the sum of the forces of life, they simply supply conditions to limit molecular transformations, both of nutrition and oxidation, but more notably of oxidation or destructive metamorphosis. Dr. M. does not say anything about his temperature either before, during, or after the operation, but it is well nigh certain that it must have been several degrees above natural, at the time the chloroform was given.
With nutrition arrested, and the waste of the body more or less increased, as would have been shown by an increase of temperature, though the waste was probably less in the nerve masses than elsewhere, as would have been shown by the state of the pupil, and the absence of mechanical phenomena, as spasms, and convulsions, the correlation of the waste, was, most likely, increased heat, which always indicates increased waste of tissue.
Third–That the chloroform, did, in fact, suspend the molecular transformations in the nerve masses furnishing the force or dynamics for the working of the heart and lungs.
Though it may never be vouchsafed to material vision to watch with the naked eye, each little molecule or particle of organic matter, break away from its highest state of organization, combining with its beloved oxygen, forming new and simple compounds, simultaneously liberating the dynamics or forces of organic life; yet, as the antecedent and consequent are definitely known, definite conceptions of the mode or modes by which the ends are accomplished, are best obtained by studying matter and force in more elementary states. Conclusions arrived at in this way, have probabilities of truth, and if they explain and harmonize all the facts, conditions and circumstances present, must be so accepted. Mental vision, however, can alone comprehend them.
Fourth—That the diminished motor power of the heart and lungs, owing to the nearly total arrest of oxidation, placed the circulation more and more under the control of the ordinary force of gravitation than it was before the chloroform was given, and as a consequence, blood arrived at and departed from the brain and nerve masses much more slowly and imperfectly, with less of the destructive as well as life giving oxygen than was necessary to carry on destructive metamorphosis to furnish the requisite force for their functions. Diminished respiration supplied less oxygen, diminished volume of circulation less blood, than was needful for the purposes of life.
Fifth-That by depressing the head and chest of the patient, the blood, obeying the law of gravity, passed to the brain and nerve masses, the then lowest portions of the body, in fuller quantity; and with the increased volume of blood, increased quantity of destructive oxygen: the conditions being supplied, destructive metamorphosis was resumed in the nerve masses, with the result of liberating more force, and with increasing force, the lungs and heart slowly resumed their functions. Dr. Mobley then and there transmuted gravity into organic forcegravity disappearing-organic force reappearing—the correlation of one mode of force into another--with the result of saving his patient's life, for the other means employed, in the absence of the conversion of gravity into organic force, must have surely failed.
This, it seems to me, presents an understandable, and to my mental vision, a most practical explanation of the phenomena attending Dr. Mobley's case of impending death from the inhalation of chloroform, and the rescue of his patient by the depression of his head and chest.
ON THE INTERNAL ADMINISTRATION OF ASTRINGENTS
BY DR. J. R. WEIST, RICHMOND, IND.
In former times, when the parts played by nature and art in the cure of disease were less definitely known than now, theory led to the administration of many and various drugs in cases of disease, and the post hoc, ergo propter hoc mode of reasoning, so common among physicians, decided upon their curative or non-curative influence, while the respect that attaches to the dicta of the fathers of medicine, lead, in many instances, to an almost universal belief in the remedial action of agents, that are now known to be either without influence, or decidedly harmful, in the conditions in which they were administered.
*Read before the Wayne County Medical Society, April 1, 1869.
We can not flatter ourselves with the belief that the errors of this kind are things of the past only, for it is a fact that can not be questioned, that despite the floods of light that have been thrown upon the real nature of many diseases, and the therapeutic action of most medicines during the last few decades by the aid of pathology, chemistry and the microscope, many physicians, at the present time, daily administer drugs with full faith and confidence in their medical action, whose claim to a place among the medical agents applicable to the condition observed, is unreal and unsubstantial.
Reflections of this kind lately passed through my mind while witnessing an alarming attack of pulmonary hemorrhage, and seeking to decide upon the best measures, medical and otherwise, to be instituted for the well being of my patient. Within the last few days, a serious case of uterine hemorrhage, of which I have had charge, has served to recall them; therefore, I propose to briefly present some of the conclusions arrived at in relation to the value in these cases of a certain class of medicines that have been, from almost "time immemorial," much relied on in the treatment of these same hemorrhages--pulmonary and uterine: I refer to astringents. I can hardly deem it necessary to refer to authorities, to sustain the statement that astringents are much relied on by the majority of the profession in the treatment of hemorrhage from the lungs and uterus, when scarcely an author is known to me, who, when detailing the treatment to be practiced in these cases, does not recommend their use upon the ground that their property of astringency will exert, if not a curative influence, at least a restraining one on the bleeding.
In presuming to question the truth of the opinions so generally held, in relation to the value of astringents when administered internally in the hemorrhages referred to, I do not for a moment deny that a certain remedial value may, and perhaps often does attach to them under such circumstances, only that this value comes from and is dependent on their astringent qualities.
To show what I mean, Prof. Harrison* among others, hold, in reference to the well known astringent, acetate of lead, that “its capability of arresting uterine hemorrhage has been most thoroughly tested by an enlarged experience of the entire body of the profession," and that “in hemoptysis its astringent property has been amply displayed." Now, while it is admitted that this “enlarged experience” may show that the medicine, acetate of lead, does sometimes exert some curative action in these cases, it entirely fails to show that it does so in consequence of any astringent quality it possesses, and that its good effects are not entirely owing to its action as a sedative. Yet this medicine, as well as alum, and the vegetable astringents, tannin, kino, catechu, rhatany, galls, &c., are administered daily in cases of hemorrhage, under the belief that they will do good in consequence of their exerting a constringing influence upon the capillary blood vessels, and the power they possess of coagulating or precipitating albumen--effects they are known to produce when externally applied to bleeding surfaces that their action is the same, whether used as external or internal medicines.
* Elements of Materia Medica and Therapeutics, volume ii, page 410.
In an effort to show that the assumption that astringents, when administered internally, control pulmonary and uterine hemorrhage by virtue of their astringency, is an entirely gratuitous one, it becomes necessary to examine the theories proposed, accounting for this supposed power, and see if they are truthful or fallacious in character.
According to Dr. Stille, * the manner in which astringents act in controlling hemorrhage, “is not regarded in the same light by all who have examined the subject." Some suppose that it is in consequence of their power to coagulate the albumen of the blood, while Dr. Headlandt holds that they "act directly and especially on muscular fibre; they cause this to contract, whether it be striped and voluntary, or of the involuntary and unstriped kind.” According to this view, “they are taken into the blood in a state of solution," they "pass through the walls of the capillaries to the muscular tissue," and stimulate to contraction the unstriped muscular fibres existing in the middle coat of the arteries, in the walls of the capillary vessels, in the lining of the ducts of glands generally, in the substance of the heart, and in the coats of the stomach and intestines." How this contraction of the muscular fibre is brought about, is not very well explained. Dr. Headland, however, says that it seems to depend somehow on the chemical power just mentioned, for astringents appear to constringe fibrinous as well as albuminous tissues by a chemical action.” The “chemical power referred to," is that by which astringents coagulate and pricipitate an albuminous or fibrinous solution.
The slightest examination of the first theory, that astringents when internally administered, control hemorrhage because of their power to coagulate the albumen of the blood, will show it to be unworthy of consideration. If it is claimed that when so administered, they have the power of coagulating the blood within the vessels, how is it that this effect is not general? That it is not so, we know, because were it so, death would be the immediate and inevitable result. And what is the wonderful intelligence that holds in abeyance the chemical affinity, which in general, causes the coagulation and precipitation of albumen, where this substance and astringents are brought into contact, while it is being passed into the blood from the stomach, conveyed in this fluid to the heart, and from thence, in the one case, to the capillary vessels of the lungs, and in the other, to the vessels of the uterus, until the very vessels themselves are reached, which are the seat of the hemorrhage? Certainly no one who exercises his reason can conclude that in this way astringents may arrest a hemorrhage of the kind we are considering. The ground that these medicines increase the coagulability of the blood, is equally untenable. Indeed, there are no facts that give plausibility to the assumption, while all the knowledge that we have in relation to their direct action upon the blood, is inconsistent with this supposition. *“Mitscherlich, having partially immersed frogs in a solution of tannic acid, so that their blood became impregnated with it, found that the circulating fluid grew darker in color, coagulated more slowly than usual, and formed an imperfect and pasty clot." This experiment, which has been performed by others with a like result, positively contradicts the theory that astringents exercise any influence in the way of increasing the coagulability of the living blood.
*Therapeutics and Materia Medica, vol. I, page 178. The Action of Medicines-astringents.
To suppose that when taken into the blood in a state of solution, they pass through the walls of the capillaries to the muscular tissues, and stimulate the muscular fibres to contraction, is to believe with Mr. Headland, that as they form peculiar insoluble compounds, both with albumen and fibrin, it is "probably by virtue of their action on the latter that they are able to cause the contraction of muscular fibre, which is a fibrinous tissue,” and that "the contraction thus set up chemically, is continued and propagated by the vital force of the muscle." While this view may serve well as a theory to explain the supposed action of astringent medicines, it is merely an assumption, it not even being proved that they constringe capillary vessels, or contract muscular fibres, except when they can be brought into direct contact with them. This view requires, First—That we assume the eapillary vessels to be contracted by the action of astringents. Sec
*Stille, op. cit.