6;o 



NA TURE 



[October 25, 1894 



This plan of treatment, although it his only recently been 

 revived, was known to Harvey, who narratei the case of a man 

 who, in consequence of an injury — Df an affront which he could 

 not revenge — was so overcome with hatred, spite, and passion 

 that "he fell into a strange disorder, suffering fron extreme com- 

 pression and pain in the heart and breast, from which he only 

 received some little relief at last when th? whole of his chest 

 was pummelled by a strong man, as the baker kneads dough."' 

 This was a very rough form of massage, but the sa-ne kneading 

 movements which Harvey described have been elaborated into a 

 complete system, more especially by Ling in SwedeD, and made 

 widely known in America and this country by Weir-Mitchell, 

 and Playlair. One might naturally expect that kneading the 

 muscles would increase the circulation through them in some- 

 what the same way as active exercise, but, to the best of my 

 knowledge, no actual experiments existed to prove this, and I 

 accordingly requested my friend and assistant, Mr. Tunnicliffe, 

 to test the matter experimentally. The method employed was, 

 in the main, the same as thai <levised byLudwig, and employed 

 by Sadler and Gaskell under his direction. The results were 

 that, during the kneading of a muscle the amount of venous 

 blood which issued from it was sometimes diminished and 

 sometimes increased ; that just after the kneading was over the 

 flow was diminished, apparently from the blood accumulating 

 in the muscle, and this diminution was again .succeeded by a 

 greatly increased flow exactly corresponding to that observed 

 by Ludwig and his scholars. 



The clinical results are precisely what one would expect 

 from increased circulation in the muscles, and cases apparently 

 hopeless sometinirs recover most wonderfully under this treat- 

 ment. For patients who are stronger, so that confinement to 

 bed is unnecessary, and who yet are unable to take walking 

 exercise, Schott's treatment is most useful, and it may be used 

 as an adjunct to the later stages of the treatment just described, 

 or as a sequel to it. Here the patient is made to go through 

 various exercises of the arms, legs, and trunk with a certain 

 amount ol resistance, which is applied either by the patient 

 himself setting in action the opposing muscles, or by an 

 attendant who gently resists every movement made by the 

 patient, but graduates his resistance so as not to cause the least 

 hurry in breathing, or the least oppression of the heart. 

 Perhaps the easiest way of employing graduated resistance is by 

 the ergostat of Gartner, which is simply an adaptation of the 

 labour crank ofprisons,where the number of turnsofa wheel can 

 be regulated in each minute, and the resistance which is applied 

 by a brake may be grjduated to an ounce. The objection to it 

 is the uniformily of movement and its wearisome monotony. 

 Oertel's plan of gradually walking day by day up a steeper and 

 steeper incline, and thui training the muscles of the heart, 

 is well adapted for stronger person-:, but when applied 

 injudiciously, may lead, just like hasty or excessive exertion, to 

 serious or fatal results. In Schott's method stimulation of the skin 

 by baths is used as an adjunct, and this may tend to slow the 

 pulse, as already mentioned. I! jt in all these plans the essence of 

 treatment is the derivation of blood through a new channel, 

 that of the muscular vessels, and the results in relieving cardiac 

 distress and pain may be described in the same words which 

 Harvey employs in reference to diseases of the circulation: 

 " How speedily some of these diseases that are even reputed 

 incurable are remedied and dispelled as if by enchantment." -' 



There is yet another consequence of the circulation to which 

 Haivey has called attention, although only very briefly, which 

 has now becime of the utmost importance, and this is the ad- 

 mixture of blood from various parts of the body. After 

 describing the intestinal veins, Harvey says : "The hlood re- 

 turning by these veins and bringing the cruder juices along with 

 it, on the one hand from the stomach, where they are thin, 

 watery, and not yet perfectly chylified ; on the other, thick and 

 more earthy, as derived from the f.-eces, l:ut all pouring into 

 this splenic branch, arc duly tempered by the admixture of 

 contraries." ' 



Harvey's chemical expressions a'e crude, for chemistry as a 

 icience only began to exist al>out a century and a half after 

 Harvey's death, yet the general idea which he expresses in the 

 words which I have just quoted is wonderfully near the truth. 



Two of the most important constituents of the blood are chlo- 

 ride ol lodium and water. Chloride of sodium is a neutral salt, but 



' " The Works of Williani Haivcy," Sydenham Societv'i Edition, p. 128. 

 -■ ///.i'., p. 141. 

 - //',;., p. 75. 



NO. 1304, VOL. 50] 



during digestion both it and water are decomposed in the 

 gastric glands, and hydrochloric acid is poured into the 

 stomach, while a corresponding amount of soda is returned 

 into the blood, whose alkalinity increases pari fassii with the 

 acidity of the stomach. I'art of this alkali is excreted in the 

 urine, so that the urine during digestion is often neutral or 

 alkaline. Possibly some of it passes out through the liver 

 in the bile, through the pancreas and intestinal glaniis 

 into the intestine, where, again mixing with the acid 

 chyle from the stomach, neutralisation takes place, so thai 

 neutral and comparatively inictive chloride of sodium is again 

 formed from the union of active alkali and acid. But it is most pro- 

 bable that what occurs in the stomach occurs also in the other 

 glands, and that it is not merely excess of alkali resulting from 

 gastric digestion which is poured out by the liver, pancreas and 

 intestine, but that these glands also decompose salts, pour the 

 alkali out through the ducts, and return the acid into the 

 blond. 



We are now leaving the region of definite fact and pass- 

 ing into that of fancy, hut the fancies are not entirely baseless, 

 and may show in',what directions we may search out and stady 

 the secrets of nature by way of experiment. For what is ap- 

 parently certain in regard to the decompj^ition of chloride of 

 sodium in the stomich, and probably in the case of neutral 

 salts in the pancreas and intestine, is also probable in that 

 important, though as yet very imperfectly known, class of bodies 

 which are known as zymogens. Just as we have in the stomach 

 an inactive salt, so we have also an inactive pepsinogen, which, 

 like the salt, is split up in the gastric glands, and active pepsine 

 is poured into the stomach. But is the pep>ine the only active 

 sul)stance produced ? Has no other body, resulting from 

 decomposition of the pepsinogen, been poured into the blood 

 while the pepsine passed into the stomach ? Has the inactive 

 pepsinogen not been split up into two bodies active when apart, 

 inactive when combined ? May it not be fiily compared, as I 

 have said elsewhere, to a cup or glass, harmless while whole, ' 

 but yielding sharp and even dangerous splinters when broken, 

 although these may again be united into a harmless whole ? ■ 



This question at present we cannot answer, but in the pancrci 

 there is an indication that something of the kind takes place. 

 Lepine has discovered that while this gland pours into 

 intestine a ferment which converts starch into sugar, it poHr> 

 through the lymphatics into the blood another lerment which [ 

 destroys sugar. Whether a similar occurrence lakes place in, 

 regard toils other ferments in the pancreas, or in the glands of 

 the intestine, we do not know, nor do we yet know whether the ' 

 same process goes on in the skin, and whether the secretion 

 sweat, which is usually looked upon as its sole function. In 

 really a rekationship to cutaneous activity similar to 1 

 which the secretion of bile bears to the functions 

 the liver. There are indications that such is the l.im., 

 for when the skin is varnished, not only does the tem- 

 perature of the animal rapidly sink, but congestion occur;. 

 in internal organs, and dropsy takes place in serous c.ivi 

 ties, while in extensive burns of the skin rapid disintegrain- 

 of the blood corpuscles occurs. It is obvious that if this ide ' 

 at all correct, a complete revolution will be required in 

 views we have been accustomed to entertain regarding liii 

 action of many medicines. In the case of purgatives and 

 diaphoretics, for example, we have looked mamly at the 

 secretions poured out after their administration for an ex-, 

 planation of their usefulness, whereas it may be that the 

 main part of the benefit that they produce is not by the 

 substances liberated through the secretions they cause, but 

 by those returned from the intestine and skin into the circu- 

 lating blood. 



How important an effect the excessive admixture of the juices- 

 from one part of the animal body with the circulating blood, 

 might have, was shown in the most striking way by 

 Wooldridge. He found that the juice of the thyroid gland, 

 though it is harmless while it remains in the gland, and is; 

 probably useful when it enters llie l)lood in small quantities in 

 the ordinary course of daily life, yet if injected into the 

 blood, will cause it to coagulate almost instantaneously 

 and kill the animal as quickly as a rifle bullei. What 

 is powerful for harm is, likewise, powerful for good in these 

 cases, and the administration of thyroid juice in cases of myx- 

 cedema is one of the most remarkable therapeutic discoveries ol 

 modern times. Since the introduction by Corvisart of pepsine 

 t Piactitioner, vol. xxxv. August 1885. 



