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ON THE PHYSIOLOGY OF RESPIRATION.
158 of opinion ; but the explanations of the fact have been very Instead of this he has given us his "views" and statements diverse. Now I beg to observe that the proofs of an impeded collected from various sources of so vague a character that for pulmonary circulation are neither solely, nor even chiefly, de- any scientific purpose they are entirely useless. It is remarkrived from the post-mortem appearances, but I will here speak able that in neither of his communications does he mention only of these, because I wish as much as possible to restrict the weight of the lungs. Instead of the weight of the lungs being given, we have such statements as that the experience myself to the points discussed by Dr. Rees. The appearances upon which I mainly rely to support my of St. Mary’s and the Middlesex Hospitals " is in accordance proposition are these : Great fulness of the systemic veins, of with that of Guy’s ; the lungs always containing blood." As the right cavities of the heart and the pulmonary artery; great if I or any one else had asserted that the lungs are absolutely fulness also of the coronary vein, with patches of ecchymoses bloodless. We are told that at the Middlesex Hospital "the near its branches, apparently the result of venous turgescence portion of the lung contained less blood than the during life. The left cavities of the heart usually contain posterior, so that the anterior portion might be called anaemic." comparatively little blood, sometimes none. The lungs, when How strange that the force of gravitation should act within the not emphysematous or restrained by adhesions, collapse to an walls of the Middlesex Hospital! But then Dr. Rees suggests extreme degree, contain less than the usual amount of blood that possibly "some such state as this may have led careless and air, and they are remarkably reduced in weight. observers into error." Such careless observers as Dr. Parkes, In order to ensure scientific accuracy, without which these for instance, might have been thus misled; but Dr. Parkes examinations are worse than useless, certain precautions are was careful to weigh the lungs and so to give us positive data. I thought I had’made it sufficiently apparent that in con. absolutely necessary. 1st. Care must be taken to ascertain that the patient died trasting the facts said to have been observed at Guy’s with in collapse, and not at the commencement of reaction, when those which had been observed "elsewhere"II was referring mainly to the researches of Dr. Parkes, confirmed as they pulmonary engorgement often comes on with great rapidity. And now I beg to say that 2nd. The body should be examined as soon as possible after have been by myself and others. death-within an hour or two; the object being to ascertain if the results of such laborious, minute, and accurate researches the precise state of the heart, lungs, and vessels at the moment into the morbid anatomy of cholera as those which were of death. The importance of this rule is obvious. If several undertaken and recorded by Dr. Parkes are to go for nothing hours elapse before the examination is made, the result is that and to be swept away by such loose and inaccurate statements when the vital contractility of the minute pulmonary arteries, as those of Dr. Rees, the sooner we give up all attempts to which during life impeded the circulation, has passed off, the establish any fact in pathology the better. I would ask Dr. blood which had been heaped up in the right cavities of the Rees if he has read Dr. Parkes’s account of the post-mortem heart and the pulmonary artery will be driven onwards by the appearances in cholera, and if so, how he explains the remarkmechanical resiliency of the tissues through the capillaries into able discrepancy between his own statements and Dr. Parkes’s that pulmonary veins and even mtn the left side nf tha heart I well-observed facts and carefully-drawn conclusions ? The distended heart and pulmonary artery will react upon and Dr. Rees declares that he has no ill feeling towards me. propel the blood, as the distended indiarubber ball in Dr. Now as I had neither accused nor suspected him of any such Richardson’s ether-spray apparatus reacts upon and propels feeling, I am tempted to say, qui s’exczsse s’accuse. I have long the air. There is a reserve of mechanical force in distended looked upon Dr. Rees as a friend, and, with his permission, I and elastic tissues. Thus the equilibrium of pressure is re- shall continue to do so. There are two sentences in his letter stored, and the distribution of the blood will be greatly which in different ways amused me greatly. The first is the changed. It will be seen, then, that not only do I agree with statement that his " views are in direct antagonism to everyDr. Rees in the opinion that the circulation must go on until thing that I have written on the subject." Surely such antathe moment of death, but I maintain that, then having been gonism as this ceases to be serious, and becomes simply ludiarrested for a time, it may in a certain fashion be resumed crous. This looks more like the undiscriminating, unreasoning after death, and the results may greatly mislead the unwary prejudice of political or pseudo-religious partisanship which morbid anatomist. can see nothing but unmixed error in an opponent’s views, than It is so very obvious that a post-mortem movement of blood, like the calm, judicial impartiality which is characteristic of to a greater or less extent, does occur in numberless instances true science. Then there is that pleasant piece of banter with that it is scarcely necessary to quote an authority in support which he concludes his letter. I should have thoroughly enof the proposition ; nevertheless, the following statement by joyed the humour of it, but my enjoyment was marred by the Harvey* is not without interest :-"I have several times somewhat saddening reflection that if only Dr. Rees’s science opened the breast and pericardium of a man within two hours were equal to his wit, what an improvement might be effected after his execution by hanging, and before the colour had in his views of cholera ! I am, Sir, your obedient servant. totally left the face, and in presence of many witnesses, have demonstrated the right auricle of the heart and the lungs disGEORGE JOHNSON. Savile-row, Jan. 21st, 1867. tended with blood ; the auricle in particular of the size of a large man’s fist, and so full of blood, that it looked as if it would burst.. This great distension, however, had disappeared ON THE PHYSIOLOGY OF RESPIRATION. next day, the body having stiffened and become cold, and the To the Editor of THE LANCET. blood having made its escape through various channels." To return to the subject of cholera, it is manifest that, apart SIR,-On considering Professor Graham’s valuable and in-* from the infliienep, of gravity whmh is always cosiderable teresting papers " On Liquid Diffusion applied to Analysis,* the tendency of the blood to shift its position after death will be greater in proportion to the distension of the right cavities and " On the Absorption and Dialytic Separation of Gases by and the pulmonary artery, so that if the examination be de- Colloid Septa, "+ it has occurred to me that these inquiries throw ferred for several hours the post-mortem engorgement of the much light on the cause and phenomena of the emission of minute tissues of the lung may actually be in an inverse ratio carbonic acid and absorption of oxygen by the lungs in the to the anaemia of the same tissues during life. of respiration ; and I trust you will kindly allow me 3. It is almost too obvious to require mention that care process offer to readers a few brief remarks on this subject. your a vein in must be taken not to puncture opening the chest, It is very obvious that venous blood on its way through the otherwise the blood, which, contrary to general opinion, is remarkably liquid, will rapidly escape and empty the veins and pulmonary circulation moistens thoroughly the pulmonary the right side of the heart. tissue or masses of air-cells directly concerned in the changes 4. The only accurate measure of the degree of anaemia or en- blood undergoes by the process of respiration. This moisture gorgement of the lungs is their weight after their large vessels or fluid consist of a solution of those substances are emptied. it is is To say of a lung that "congested," no which areappears to for the nutrition of the tissue of the lungs; more than may with truth be said of any lung, for a lung required which is nearly bloodless will surely be gorged with blood in but whatever be its nature, it is certainly derived from the its under part. blood, and as much moisture is constantly being expired, we If Dr. Rees had given us a detailed statement of even a few may safely assume that the fluid or solution under our present post-mortem examinations, assuring us at the same time that consideration evaporates at the surface of the lungs into the careful he had been to avoid all the sources of fallacy which I out, his facts would have had a certain value. air-cells, a current being thereby established from the blood
anterior
have pointed Second
Disquisition on the Circulation of the Blood. Sydenham Society’s
Translation,
p. 13*.
.
Philosophical Transactions, 1861, p.183.
+ Ibid., 1866, p. 399.
159 outwards. The membrane through which this current occurs may be looked upon, in its connexion with the carbonic acid of venous blood, as a colloid mass or colloid septum free from pores, through which carbonic acid has to pass on its way out of the lungs, and oxygen on its way into the blood. Now, Prof. Graham has shown that acids which form with bases crystallisable compounds, such as hydrochloric and nitric
acids,
have the power of
diffusing themselves very readily into
colloid mass, and of passing with very great rapidity into water through a thin colloid septum. We may, therefore, expect that carbonic acid, which forms with bases highly crystallisable compounds, will, when in solution, be possessed of diffusible properties in a considerable degree. It may consequently, I think, be safely considered that the passage of carbonic acid from the blood through the tissue of the lungs is due to a phenomenon of liquid diffusion of the dissolved gas, and accelerated by the high temperature of the body and the current produced by the evaporation of moisture at the surface of the lungs. We have now to account for the evolution of carbonic acid into the air chambers or vesicles. To explain this phenomenon, the reader has merely to bear in mind the very familiar fact, that by heating water containing carbonic acid the gas is expelled from it. I have attempted to show by what process carbonic acid contained in venous blood reaches the external surface of the lungs; we may now assume that it simply evaporates from the heat of the body, along with the moisture subsequently found in the breath. Air is constantly being renewed in the pulmonary cavity, so that the carbonic acid which evaporates at the surface of
a
the lungs is in a great measure carried away at each expiration. Should the amount of air inspired be insufficient to remove the carbonic acid from the air vesicles, the gas will accumulate therein, and diffuse itself back again into the moist membrane and into the blood. Graham has shown that gases diffuse themselves through colloid septa in which they are soluble; and as carbonic acid is comparatively soluble in water, it will be taken up readily by a membrane moistened with an aqueous solution, and delivered into the blood. The evolution of carbonic acid at the lungs may be considered as regulated by four different means :1. The amount of carbonic acid contained in the blood. 2. The degree of readiness with which the dissolved carbonic acid permeates the tissue of the lungs. 3. The temperature of the 4. The amount of air taken into the lungs at each in-
lungs.
spiration. In the state of
COMPENSATION FOR RAILWAY INJURIES. To the Editor
of THE
LANCET.
SIR,-Dr. Reynolds may not have gone so far as the other two witnesses whose names have been mentioned, but certainly made statements which along with theirs led the jury to regard the case as so serious, and to give such large damages (E4700). According to what was stated at the trial, the plaintiff should by this time be either dead or dying ; and when I said that, on the contrary, he admitted his being quite well, I did not intend to allege that he had done so in words, since this would have been a degree of ingenuousness hardly to be expected under the circumstances. When I heard that this person’s late agent (Mr. Officer) had reported so favourably of his health; when I heard that his late medical attendant (Mr. Balfour), who resides in the same town, had frequently seen him walking about apparently quite well; and when I heard that on the day before Christmas, having come from Portobello to Edinburgh, he had publicly appeared in the crowded jury court during a trial in which he had no personal interest, I did not suppose that he could any longer profess to remain on the sick list ; and I still think that he cannot properly do so, however inconsistent this opinion may be with the flippant remarks of Dr. Reynolds, and the lawyer who has come to his assistance. T am. Sir vour obedient servant. JAMES SYME. Edinburgh, Jan. 28th, 1867. To the Editor
of THE LANCET.
SIR,-In your issue of January 5th I observe a communication from Mr. Syme on the’subject of Compensation for Railway Injuries. With his views in regard to the injustice of the legal enactments of our country, and the unsatisfactory character of the verdicts of juries upon claims for compensation on account of personal injuries, or the illustration he gives in support of his views by reference to the somewhat famous case of Denham v. the Great Northern Railway Company, I have nothing to do. In the case " of medical diversity that has just occurred here," as Mr. Syme somewhat quaintly terms it, I have, however, a personal concern, seeing that the so-called surgeon of experience in such cases"was myself. This must be my excuse for trespassing on your valuable space, and requesting to be allowed to give your readers and the profession generally the facts of the case, upon which they may base their own conclusions. In so doing I only respond to Mr. Syme’s wish for the "publication of cases exhibiting an entire discrepancy between the medical evidence, and shall be glad if I can thus assist "to check the reckless advocacy of one-sided views." On the 28th of April last I was requested to visit a commercial traveller at his hotel. On calling I found him lying He complained of pain in his upon a couch in his bedroom. head and back, in consequence of a railway concussion two
health, the exit of carbonic acid from the is thus perfectly regulated; but should any of these conditions for the normal elimination of this gas be deficient or in any way altered, as from some disease of the tissue of the lungs, or from the temperature of the body being depressed, or from the volume of air inspired being too small, then carbonic acid will be retained and accumulate in the blood, adding to the existing disease. The absorption of oxygen by the lungs must, I believe, be considered, according to Graham’s discovery, as due to the days previously, near Berwick-upon-Tweed. He stated that solubility of oxygen in the colloid pulmonary membrane at the ! when the accident occurred he was thrown violently forwards, temperature of the lungs; and I conceive it as finding its way then backwards, and on recovering his senses found himself into the blood by a process of diffusion, just as carbonic acid lying upon the floor of the carriage ; that on reaching Berwick moved out of it, and somewhat in the same way as rain-water by omnibus he walked about half a mile (not a mile and a is distributed throughout the soil of a field (a process which is, half, as Mr. Syme states) to see Dr. Maclagan, who, Mr. Syme however, one of distribution by porosity), to be finally carried says, "assured the patient that there was no local injury or away by the drains. If there is enough oxygen in air to occasion for confinement," but who, in a statement furnished saturate the pulmonary membrane, the inhalation of oxygen by him of the evidence he was prepared to give at the trial, gas as a means of introducing more of it into the blood will states his opinion as follows, " It seemed to me that Mr. fail; but should this tissue be capable of holding more oxygen thought all risk was over, but that was not my opinion. I in solution than is supplied to it by the air inspired, then we recommended him to take complete rest for some days. As a physician I should certainly say that a person receiving a may expect beneficial results from the treatment. shock such as Mr. to of the the did, would not feel the effects of it view, present by According absorption oxygen the lungs will depend upon and be regulated by the readiness immediately so much as he would do some days after the with which the oxygen inspired is taken up or absorbed by shock, and that was my reason for recommending perfect rest the membrane of the lungs, and the rate at which it diffuses for a time." The patient having, notwithstanding, come on itself into the blood. A thickening or other morbid state of the to Edinburgh, went, by the advice of his hotel-keeper to conlungs, by interfering with the absorption and diffusion of oxygen sult Mr. Syme. In his evidence given upon oath at the trial throughout their tissue, will, it may reasonably be expected, add the claimant stated : "Mr. Syme requested me to return home to the constitutional disorder by impeding the admission of and foment my back with flannel and hot water, and that in oxygen into the blood : it is important to bear in mind this a few days I would know what was the matter ;" a somewhat circumstance for the rational treatment of this class of diseases. irreconcileable statement with that of Mr. Syme, who found there was no local complaint "-(Why then did he recomI beg to remain. Sir, your obedient servant, mend hot fomentations to the back?)--and concluded that WILLIAM MARCET, M.D.,F.R.S. "if he felt any uneasiness it must be more mental than Harley-street, Jan. 19th, 1867.
body
-
-
anterior
have pointed Second
Disquisition on the Circulation of the Blood. Sydenham Society’s
Translation,
p. 13*.
.
Philosophical Transactions, 1861, p.183.
+ Ibid., 1866, p. 399.
159 outwards. The membrane through which this current occurs may be looked upon, in its connexion with the carbonic acid of venous blood, as a colloid mass or colloid septum free from pores, through which carbonic acid has to pass on its way out of the lungs, and oxygen on its way into the blood. Now, Prof. Graham has shown that acids which form with bases crystallisable compounds, such as hydrochloric and nitric
acids,
have the power of
diffusing themselves very readily into
colloid mass, and of passing with very great rapidity into water through a thin colloid septum. We may, therefore, expect that carbonic acid, which forms with bases highly crystallisable compounds, will, when in solution, be possessed of diffusible properties in a considerable degree. It may consequently, I think, be safely considered that the passage of carbonic acid from the blood through the tissue of the lungs is due to a phenomenon of liquid diffusion of the dissolved gas, and accelerated by the high temperature of the body and the current produced by the evaporation of moisture at the surface of the lungs. We have now to account for the evolution of carbonic acid into the air chambers or vesicles. To explain this phenomenon, the reader has merely to bear in mind the very familiar fact, that by heating water containing carbonic acid the gas is expelled from it. I have attempted to show by what process carbonic acid contained in venous blood reaches the external surface of the lungs; we may now assume that it simply evaporates from the heat of the body, along with the moisture subsequently found in the breath. Air is constantly being renewed in the pulmonary cavity, so that the carbonic acid which evaporates at the surface of
a
the lungs is in a great measure carried away at each expiration. Should the amount of air inspired be insufficient to remove the carbonic acid from the air vesicles, the gas will accumulate therein, and diffuse itself back again into the moist membrane and into the blood. Graham has shown that gases diffuse themselves through colloid septa in which they are soluble; and as carbonic acid is comparatively soluble in water, it will be taken up readily by a membrane moistened with an aqueous solution, and delivered into the blood. The evolution of carbonic acid at the lungs may be considered as regulated by four different means :1. The amount of carbonic acid contained in the blood. 2. The degree of readiness with which the dissolved carbonic acid permeates the tissue of the lungs. 3. The temperature of the 4. The amount of air taken into the lungs at each in-
lungs.
spiration. In the state of
COMPENSATION FOR RAILWAY INJURIES. To the Editor
of THE
LANCET.
SIR,-Dr. Reynolds may not have gone so far as the other two witnesses whose names have been mentioned, but certainly made statements which along with theirs led the jury to regard the case as so serious, and to give such large damages (E4700). According to what was stated at the trial, the plaintiff should by this time be either dead or dying ; and when I said that, on the contrary, he admitted his being quite well, I did not intend to allege that he had done so in words, since this would have been a degree of ingenuousness hardly to be expected under the circumstances. When I heard that this person’s late agent (Mr. Officer) had reported so favourably of his health; when I heard that his late medical attendant (Mr. Balfour), who resides in the same town, had frequently seen him walking about apparently quite well; and when I heard that on the day before Christmas, having come from Portobello to Edinburgh, he had publicly appeared in the crowded jury court during a trial in which he had no personal interest, I did not suppose that he could any longer profess to remain on the sick list ; and I still think that he cannot properly do so, however inconsistent this opinion may be with the flippant remarks of Dr. Reynolds, and the lawyer who has come to his assistance. T am. Sir vour obedient servant. JAMES SYME. Edinburgh, Jan. 28th, 1867. To the Editor
of THE LANCET.
SIR,-In your issue of January 5th I observe a communication from Mr. Syme on the’subject of Compensation for Railway Injuries. With his views in regard to the injustice of the legal enactments of our country, and the unsatisfactory character of the verdicts of juries upon claims for compensation on account of personal injuries, or the illustration he gives in support of his views by reference to the somewhat famous case of Denham v. the Great Northern Railway Company, I have nothing to do. In the case " of medical diversity that has just occurred here," as Mr. Syme somewhat quaintly terms it, I have, however, a personal concern, seeing that the so-called surgeon of experience in such cases"was myself. This must be my excuse for trespassing on your valuable space, and requesting to be allowed to give your readers and the profession generally the facts of the case, upon which they may base their own conclusions. In so doing I only respond to Mr. Syme’s wish for the "publication of cases exhibiting an entire discrepancy between the medical evidence, and shall be glad if I can thus assist "to check the reckless advocacy of one-sided views." On the 28th of April last I was requested to visit a commercial traveller at his hotel. On calling I found him lying He complained of pain in his upon a couch in his bedroom. head and back, in consequence of a railway concussion two
health, the exit of carbonic acid from the is thus perfectly regulated; but should any of these conditions for the normal elimination of this gas be deficient or in any way altered, as from some disease of the tissue of the lungs, or from the temperature of the body being depressed, or from the volume of air inspired being too small, then carbonic acid will be retained and accumulate in the blood, adding to the existing disease. The absorption of oxygen by the lungs must, I believe, be considered, according to Graham’s discovery, as due to the days previously, near Berwick-upon-Tweed. He stated that solubility of oxygen in the colloid pulmonary membrane at the ! when the accident occurred he was thrown violently forwards, temperature of the lungs; and I conceive it as finding its way then backwards, and on recovering his senses found himself into the blood by a process of diffusion, just as carbonic acid lying upon the floor of the carriage ; that on reaching Berwick moved out of it, and somewhat in the same way as rain-water by omnibus he walked about half a mile (not a mile and a is distributed throughout the soil of a field (a process which is, half, as Mr. Syme states) to see Dr. Maclagan, who, Mr. Syme however, one of distribution by porosity), to be finally carried says, "assured the patient that there was no local injury or away by the drains. If there is enough oxygen in air to occasion for confinement," but who, in a statement furnished saturate the pulmonary membrane, the inhalation of oxygen by him of the evidence he was prepared to give at the trial, gas as a means of introducing more of it into the blood will states his opinion as follows, " It seemed to me that Mr. fail; but should this tissue be capable of holding more oxygen thought all risk was over, but that was not my opinion. I in solution than is supplied to it by the air inspired, then we recommended him to take complete rest for some days. As a physician I should certainly say that a person receiving a may expect beneficial results from the treatment. shock such as Mr. to of the the did, would not feel the effects of it view, present by According absorption oxygen the lungs will depend upon and be regulated by the readiness immediately so much as he would do some days after the with which the oxygen inspired is taken up or absorbed by shock, and that was my reason for recommending perfect rest the membrane of the lungs, and the rate at which it diffuses for a time." The patient having, notwithstanding, come on itself into the blood. A thickening or other morbid state of the to Edinburgh, went, by the advice of his hotel-keeper to conlungs, by interfering with the absorption and diffusion of oxygen sult Mr. Syme. In his evidence given upon oath at the trial throughout their tissue, will, it may reasonably be expected, add the claimant stated : "Mr. Syme requested me to return home to the constitutional disorder by impeding the admission of and foment my back with flannel and hot water, and that in oxygen into the blood : it is important to bear in mind this a few days I would know what was the matter ;" a somewhat circumstance for the rational treatment of this class of diseases. irreconcileable statement with that of Mr. Syme, who found there was no local complaint "-(Why then did he recomI beg to remain. Sir, your obedient servant, mend hot fomentations to the back?)--and concluded that WILLIAM MARCET, M.D.,F.R.S. "if he felt any uneasiness it must be more mental than Harley-street, Jan. 19th, 1867.
body
-
-