no Disturbances of Circulation. 



plete filling of the pulmonary artery, pulmonary anaemia, and, of course, the 

 left heart in its turn receives unduly low amounts of blood. In the right 

 auricle and larger veins engorgement ?.nd tension become marked, tending 

 to cause a passive engorgement of the venous system throughout the body, 

 a cyanotic liver, cyanotic spleen, etc. 



A heart reduced in its propulsive power is itself but poorly 

 supplied with blood because its own arteries are but incompletely 

 supplied. Any condition of fatigue which prevails may there- 

 fore easily become c.vhaiistion, complete functional inability, arrest 

 of cardiac action ( cardiac paralysis, cardiac syncope, cardiac col- 

 lapse). All these terminal changes interfering with circulatory 

 integrity are occasioned by any influences which impair the con- 

 tractile efficiency of the myocardium, any agencies which either 

 directly or indirectly reduce its muscular power (rupture, fatty 

 degeneration, inflammation, prevention of expansion of the heart 

 from some external interference, anaemia) ; in the same way the 

 action of some paralyzant toxine upon the cardiac ganglia, the 

 analogous action of thermic and electric agencies, excessive reflex 

 stimulation of the vagus or of the vagus nucleus in the medulla 

 oblongata (the latter from deficiency of the blood oxygen, 

 increased blood pressure in the brain, or toxines). 



Just as in cases of diseases of the heart, affections of the 

 arteries and veins are apt to occasion irregularity of distribution 

 and movement of the blood in given organs and areas of the 

 body. Narrow'ing of the arteries from vasoconstriction (arterial 

 spasm), thrombus formation, inflammation and permanent shrink- 

 age raise the intracardiac blood pressure and occasion dilata- 

 tion and hypertrophy ; the organ to which such a constricted 

 artery is distributed is imperfectly supplied wath blood and a 

 variety of changes may in consequence occur in it (cf. ancrniia 

 and embolism). Decrease in the elasticity of the vascular walls 

 or paralysis of the arterial musculature permits the vessels to 

 dilate, the current to become slowed and the organ, congested. 

 Reduction in the muscular jionus of the vessels of the splanchnic 

 area from vasomotor paralysis, usually from toxic and infectious 

 influences, causes a massive congestion of the abdominal vessels ; 

 in consecjuence of which the general- blood pressure falls, cardiac 

 labor from the small amount of blood coming to the organ ensues, 

 and there is a fatal collapse (Krehl). 



In the veins interference with the progression is occasioned 

 not only by cardiac weakness, cardiac lesions and pulmonary 



