concludes from his work in Koch's Institute that tuberculin is of no value in cases of phthisis attended with secondary infections. He holds that it is best to begin with very small doses,-less than 0.1 of a milligram, and then to increase rather rapidly. He believes that a permanent cure can be achieved with tuberculin, especially if the patient is subjected to a periodic course of treatment. Usually two courses suffice. The author reports 22 cases, 4 being advanced and 18 milder cases; in all the tuberculin brought about an apparently complete cure. Krause 1 reports 41 cases of phthisis treated with tuberculin. Thirty of these were uncomplicated, while 11 showed mixed infection. He considers that 12 of these were practically cured, temporarily at least; but he admits that in none of these cases were tubercle bacilli found. He states that the earliest injections are likely to cause considerable pain; and when this does not disappear after a few repetitions, he discontinues the use of the tuberculin. He stands almost alone in considering T. R. more dangerous than the old tuberculin. Validol. This is a compound of menthol and valerianic acid. It is a colorless liquid, of cool, slightly bitter taste. The dose is from 10 to 15 drops, on sugar. Goldmann 2 recommends it in neurasthenia; Cipriani, in the treatment of anorexia and vomiting of phthisis; and Vertrun, in the vomiting of pregnancy. Vanadium. The salts of vanadium-sodium, iron, and lithiumhave found favor as alteratives with a number of observers. Anceau 5 has found sodium vanadate a powerful tonic and reconstructive in tuberculosis. He recommends of a grain daily by the mouth. Bertheil 6 has employed vanadium salts in over 140 cases. He prescribes the sodium salt in aqueous solution, in doses of from to of a grain in 24 hours. According to the author, the most important applications of the drug are as follows: In tuberculosis, when good results are at least temporarily obtained. The appetite returns, bodily vigor increases, and the general condition becomes notably improved. Gastric disturbance, however, is noted as an unfavorable feature in these cases. In anemia and chlorosis the results are conclusive, the vanadate of iron being employed. In neurasthenia sodium phosphovanadate has given excellent results. In diabetes the results have been in certain cases very remarkable, especially on the glycosuria and the acetonuria. In gout sodium vanadate, and more especially lithium vanadate, produce marked effects on the subacute articular pain. The vanadium medication, finally, has been known to effect, temporarily at least, the growth of neoplasms, and it has been of service in malaria and in certain skin affections. 1 Deut. med. Woch., May 18, 1899. 3 Allg. med. Central. Zeit., No. 75. 5 Thèse de Paris, 1899. 2 Klin.-therap. Woch., No. 33. 1899. Berl. klin. Woch., No. 3, 1899. Thèse de Lyon, 1899. PHYSIOLOGY. BY G. N. STEWART, M.D., OF CLEVELAND, OHIO. BLOOD. Quantity of Blood in the Body.-Haldane and Lorrain Smith 1 have determined the total mass of the blood in man by causing the person to inhale a known volume of carbonic oxid mixed with oxygen and then determining in a sample of blood the percentage amount to which the hemoglobin has become saturated with CO. From this the amount of CO capable of being taken up by the whole of the blood can be calculated. All that remains is to estimate the volume of CO (or, what is precisely the same thing, the volume of O) which 100 gm. of blood will take up (that is, the percentage oxygen capacity). From these data we get at once the quantity of blood in the body, which, according to Haldane and Smith, has hitherto been greatly overestimated. They find that it is, on an average, only about 4.9% (205) of the bodyweight, varying in 14 persons between 3.34% (3%) and 6.27% (1) of the body-weight. In chlorosis and pernicious anemia Smith 2 states that the quantity of the blood is markedly increased; in one case of pernicious anemia to of the body-weight. This is due to the increase in the plasma. The total oxygen-capacity (i. e., the total quantity of O which the blood will take up) is, according to the same authors, in a normal individual about 0.85 liters for 100 kilos of body-weight. It is but little altered in chlorosis, but is markedly diminished in pernicious anemia. In both diseases the percentage oxygen-capacity is greatly lessened, owing to the decrease in the number of red corpuscles and in the amount of hemoglobin. [Gréhant and Quincke have previously employed the inhalation of CO to determine the quantity of blood in the dog, and, comparing it with Welcker's method, have found that it yielded accurate results. It is clear that the whole method rests on the assumption that CO is not to any appreciable extent destroyed in the body during the period of the experiment. Various observers have been led to the contrary result, among others Wacholtz, whose experiments, however, we adversely commented upon in a previous report.4 Haldane, after repeating Wacholtz's work, now rejects it altogether, and finding no 1 Jour. Physiol., vol. xxv, p. 331; Proc. Physiol. Soc., p. v. 2 Proc. Physiol. Soc., p. vi. 3 Pflüger's Arch., Bd. LXXIV, S. 174; Ibid., Bd. LXXV. S. 341. 4 YEAR-BOOK for 1900, Medicine, p. 506. 5 5 Jour. Physiol., vol. XXV, p. 225. evidence that CO is oxidized in the body, reiterates the accuracy of his method, which appears to be based on sound principles.] 6 Osmotic Relations of Blood.-Oker-Blom,1 in a series of elaborate researches on the electric conductivity and general osmotic relations of the corpuscles and plasma, confirms the conclusion of Roth,2 Stewart, 3 and Bugarsky 4 that the red corpuscles are nonconductors in comparison with the plasma, and the results of Stewart on the effect of dilution of the blood on its conductivity. A. Rollett 5 also confirms the conclusions of the latter as to the effects produced when blood is laked by various reagents, and especially his statement that the hemoglobin and electrolytes may be caused to leave the corpuscles independently [a fact of considerable interest in connection with the question of the relation of the hemoglobin to the stroma of the corpuscles.] Rollett sees in his work a further proof of the correctness of his view that the corpuscle is not a mere vesicle, but contains a framework of semisolid stroma.~ [And, indeed, we do not believe that the contrary theory can be any longer maintained in face of the chemicophysical results of the past two or three years.] Coagulation of Blood.-W. H. Thompson 7 has shown that the protamins (substances hitherto obtained only from the ripe milt of certain fishes and believed by Kossel to be the simplest proteids) exert, when injected intravenously, a retarding influence on coagulation, diminish the number of leukocytes, and lower the blood pressure, just as albumoses do. They also affect the respiration, causing first exaggeration, then a gradual diminution, and then cessation. These effects are partly due to a direct depressing action on the respiratory muscles. CIRCULATION. Action of Na, Ca, and K Ions on the Heart.-An important series of papers has been published by J. Loeb on the effect of various ions on rhythmic contraction in general and particularly on the rhythmic contraction of the heart. He starts with the observation that a striated muscle in a normal NaCl solution (or in the equimolecular solution of any other Na salt) may go on contracting rhythmically for from 24 to 48 hours, while Ca and K ions only inhibit these contractions. Nevertheless the muscle remains longer alive when a small amount of CaCl, and KCl is added to the NaCl solution. Loeb explains the seeming paradox by the hypothesis that the Na ions are the real stimulus for the rhythmic contractions, but yet exert on the muscular tissue a poisonous influence, which is neutralized by the Ca and K ions. He finds support for the idea that the Na ions are actually 1 Pflüger's Arch., Bd. LXXIX, S. 111; Ibid., S. 510; Ibid., Bd. LXXXI, S. 167. 2 Centralbl. f. Physiol., Bd. XI, July 10, 1897. Ibid., Aug, 7, 1897; Jour. Bost. Soc. Med. Sci., June 3, 1897; Jour. Physiol., vol. XXIV, p. 211. Centralbl. f. Physiol., July 24, 1897. 5 Pflüger's Arch., Bd. LXXXII, p. 199. 6 YEAR-BOOK for 1899, p. 950; Ibid. for 1900, p. 501. 7 Zeit. f. physiol. Chem., Bd. XXIX, S. 1. Fick's Festschrift, Braunschweig, 1899. poisonous to the living substance in the fact that Fundulus heteroclitus a small marine fish, with so marvelous a range of adaptation that it will live in sea-water to which NaCl has been added to the amount of 5%, and, on the other hand, in fresh and even in distilled water, 2-will not live in pure NaCl solutions of about the same osmotic pressure as sea-water, but will survive in NaCl solutions even twice as strong if a little CaCl2 or KCl be added. The K ions are, therefore, only indirectly necessary in order to neutralize the poisonous action of the NaCl. In another paper 3 he extends his conclusions as to the poisonous action of Na ions and the protective action of Ca and K ions to many other marine animals, and defends it against the obvious objection that, according to current physiologic doctrine, the Ca and K ions are indispensable for the contraction of the cardiac muscle. As a matter of fact, according to J. Lingle, one of Loeb's pupils, a pure NaCl solution has an injurious effect upon the ventricular muscle of the turtle, while Ca and K ions improve the rhythm by neutralizing this injurious action. The reason for all these peculiar effects of the Na, Ca, and K ions Loeb finds in the formation by them of combinations with the proteids of the living substance, which he imagines to remain contractile only so long as the combination contains all three classes of ions in proportions varying within certain definite limits. In a pure NaCl solution the Na ions get the upper hand, and the balance is upset. He even goes so far as to say that the normal proportions of Na, Ca, and K ions vary in different kinds of tissues, as in muscle and nerve, so that in Gonionemus (one of the Hydromedusæ), e. g., myogenic contractions are prevented by a smaller amount of K and Ca ions in the surrounding NaCl solution than neurogenic contractions originating in parts containing ganglia. Influence of Chloroform on the Heart.-J. A. MacWilliam, 5 whose previous accurate researches on this subject have so much advanced our knowledge, returns to the question in a paper on the effect of the drug on the rate of the pulse. He states that in the cat, as in man, there is first a stage of acceleration and then a stage during which the heart beats more slowly than normal. The acceleration essentially depends on a diminution in the activity of the vagus center; and the subsequent slowing, partly on increased activity of that center and partly on a direct action of the drug on the heart itself, not connected with the changes in the blood pressure. An important practical point is that at a certain stage in chloroform anesthesia, before it has become very deep, comparatively trifling causes may bring about great and sudden changes in the pulse-rate, owing to the abnormal mobility of the vagus center. Sudden arrest of the respiratory movements causes effects that vary at different stages of the anesthesia, but always terminate in a phase of slowing and irregularity. Tetanus of the Heart.-[Few questions in physiology have been more generally discussed than the possibility of causing a true tetanus 1 Pflüger's Arch., Bd. LXXX, p. 229. 2 Ibid., Bd. LV. 4 Am. Jour. Physiol., vol. IV, p. 265. XXV, p. 233. of the heart. That it is difficult to do so under ordinary conditions is admitted by all, and most systematic writers have explained the difficulty as due to the long refractory period of the cardiac muscle.] E. v. Cyon believes that he has discovered evidence that the phenomenon is not related to any peculiar property of the muscle of the heart, but to the existence in its walls of automatic nerve-centers, motor and inhibitory, which, so long as they are acting in normal coordination, hinder the achievement of complete tetanus. [We must say that Cyon's explanation is rather a nebulous one, but, such as it is, he finds support for it in the fact that a frog's heart which has been brought to a standstill by heating it to 40° C., and in which, according to him, the inhibitory apparatus has been put out of gear, can be tetanized by stimulation of the vagus. But while it may be considered certain that the refractory period of the heart is diminished and its capacity for entering into tetanus increased by raising the temperature, we can not accept Cyon's, view that stimulation of the inhibitory fibers has anything to do with the outburst of very rapid contractions caused by excitation of the frog's vagus during heat-standstill of the heart. On the contrary, it was shown long ago by the author of this abstract 2 that the phenomenon was due to stimulation of the sympathetic augmentor fibers in the nerve.] The experiments of O. Frank and Rouget, who obtained tetanus of the heart by simultaneous excitation of the vagus and sinus venosus, and those of A. Walther, 5 who obtained it by exciting a heart poisoned with muscarin with strong interrupted currents, are much more conclusive than those of Cyon, and indicate that there is some relation between the inhibitory mechanism and the production of tetanus. The Intersystole of the Heart.-[It has often been debated whether any appreciable interval exists between the end of the auricular and the beginning of the ventricular systole of the warm-blooded heart. According to Chauveau, not only is this period (the intersystole) well marked and sharply delimited (in the horse), but it is occupied by a definite series of events. In particular, the contractions of the papillary muscles produce changes during this period in the interior of the ventricles. He refers [in gently ironical terms] to the recent work of Potain, who could find no intersystole at all, and finally dismisses it [as we can] with the remark that Potain's results must have been due to imperfect technic. 7 Electric Changes in the Heart.-W. Einthoven and K. de Lint 8 have published some beautiful records [the best we have seen] of the electric changes that accompany the beat of the human heart. They show that exercise has a marked effect on the electrocardiogram, which is, moreover, altered in disease (aortic insufficiency). P. Rivière, after 1 Jour. de Phys. et de Path. gén., tome II, p. 395; Ibid., p. 644. 2 Jour. Physiol., XIII, p. 59. 4 Arch. de Physiol. norm. et path., 1894. 9 3 Zeit. f. Biol., Bd. XXXVIII, p. 300. 5 Pflüger's Arch., Bd. LXXVIII, p. 597. Jour. de Phys. et de Path. gén., tome II, p. 125. Jour. de Phys. et de Path. gén., tome II, p. 101. Pflüger's Arch., Bd. LXXX, S. 139. Jour. de Phys. et de Path. gén., tome II, p. 275. |