Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    192/976 (page 172)
    and of much congestion of the lungs. The brain and membranes sometimes full of blood, as in low fevers, in which the blood is in fault. The blood coagulates loosely. Of course to these must be added gangrenous patches, bedsores, ulcers, ulcerated cornese, boils, suppurated or swollen parotid glands, gangrene of lungs, ecchymoses, and purpuric, or scorbutic patches, which occur occasionally. Pathology dueing Life.—Prom the study of cholera as shown in the symptoms and post-mortem appearances, we pass to an attempt to account for them. In the section on Etiology the nature of the cause has been discussed. We have now to suppose that a poison has entered the blood in some manner, either by the channel of the lungs or intestinal surface. The poison acts through the blood, possibly in the manner of a ferment; but we do not know whether it acts by a catalytic influence on the blood mass, or whether it multiplies itself in the blood, or not; we are very much in the dark. However, if we cannot trace the minute action of the poison we are able to guess at some of its effects. It appears that at least two great sets of capillaries and small arteries are involved in them : those of the lungs and intestines. They seem to be very differently influenced by it. In the lungs very little of the blood passes freely through them in the algide stage. In the intestines an enormous quantity of certain of the blood elements pass through the capillary walls in the exudation period. In both of these sets of actions, parts of the nervous system appear to be, under a morbid influence. In the lungs the muscular fibres of the small arteries seem thrown into a state of contraction. In the intestines a sort of paralysis of the smaller arteries and capillaries seems to exist, much as occurs in the sections of the sympathetic nerve in the neck in Bernard’s ex- periments. That the morbid action in the lungs is of nervous character seems probable from the absence after death of any discoverable mechanical obstacle to the passage of the blood, from the paroxysmal nature of the dyspnoea at first, and from the ease with which the pul- monary circulation is re-established when recovery begins. The nervous character of the actions in the intestines seems probable from its ana- logy with the results of Bernard’s experiments on the sympathetic, in some of which a section of that nerve in the neck caused the surface of the skin supplied by the vessels under its influence to become bathed in sweat. It is a matter of dispute whether the disturbances in the lungs and the exudation through the intestinal walls are both effects of the poison, or whether the exudation into the intestinal canal having taken place, the pulmonary symptoms may not be due to the altered r.nnrlif.inn nf I.Vip Klnnrl p.nnsfirl hv its beinp-inspissated thl’0U2'h tile exu-