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VOL. IX. NO. IV. 28



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434 Bernard on the Abdomino- Renal Circulation.

will find a part of it only in the blood, there being a certain aroount of
it which id really destroyed in passing. This species of sugar is also
modified by the liver, which gives it a different physiological character.

Diabetic sugar, corresponding chemically with that of the grape, dif-
fern from it physiologically, as it is more easily absorbed and destroyed
when injected into a vein.

The results of these observations teach us, that it is essential for all
sugar to pass through the liver to undergo the fermentation and destruc-
tion, which its simple passage through the intestines is insufficient to
comfilete.

Albumenous substances, also, M. Bernard has ascertained, must pass
through the liver to receive the modifications essential to its complete
absorption into the system. This is found in the lymphatics and in the
vena porta, which are so difficult to experiment upon. lie injected the
albumen of egi^s into the jugular vein, and it made its appearance in
the urin^; hence, of course, it does not remain as a nutritive product
in the bloo'l, though portions are also found in that fiuid — (another
variety uf albumen, when injected in like manner, ivas eliminated by
the kidneys) — hence both require the liver for their complete transfor-
mation. The same alUumen, injected into the vena porta, passes
directly to the liver, and you find none of it in the urine.

Faity matt<^r does not enter the liver, as is well known, but it first
passes to the lungs, when it is thrown directly into the general current
of the circulation. There is a slight absorption of a small portion of it
ill the vena porta, but this is absorbed naturally and through no cherai-
ctl chaiiije. It is nut emulsionized as it is by the pancreas. This
small portion, taken up by the vena porta, goes to the liver as fat, where
it di^appf^ars. M. Bernard couM discover no trace of its presence in
the blood which had left the liver. Some physiologists sustain the
opinion, that in this organ it enters into the formation of sugar ; but
this is not verifi'd. It certainly di«»appears there, and does not pass out
of the liver as fat; it may help to form bile.

So that the liver require^ three kinds of substances — sugar, starch,
and thrt small quota of fat just referred to.

C yliferous vesseU, — These are e8pe<nally subservient to the absorp-
tion of fat Tlvy are not found in fishes or birds ; M. Bernard has
fed pigeons on fat. and, upon examination, lymph was found in the
vessels, but no fatty matter in suspension. In birds the latter is proba-
bly absorbed by the vena porta. In these animals the vena porta com-
municat'ft largely with other veins, and there is, therefore, n* absolute
necessity for their contents to pass through the liver.



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Bernard on the Abdomino* Renal Circulation, 435

The liver thus appears to be interposed between the intestines and
the grand circuiatorj sjsten), to modify certain substances preparatory
to their entrance, and prepare certain products tor their elimiuatioii.

The liver has another duty to perform, viz : to prepare an equili-
brum between certain substances ; as, for instance, when the propor-
tions between flesh, viands and ordinal^ food, varies ; whetlit:r one is
introduced in too great quantity, or the reverse, it is the liver which
makes up for the deficiency, or converts what is superabundant into
another proiluct more congenial to the requirements of the system.

An animal, nourished exclusively on viands, has the»e azotized sub-
stances conveited by the liver into sugar; and the exclusive diet pro-
duces no effect upon the blood proportionate to the quantity introduced
by means of its reduction during its passage through this organ, which
exists, as it were, as a balance to preserve from the injurious influences
of excess. Its anatomical position, also, with relation to the other
organs, supports this idea founded on its phy8ii»logical action.

There are three maladies affi-cling the human economy, which de-
pend upon different modifications of the liver and its secretion, viz:
diabetes, albumenuria, and fatty or chylou:i urine. But these need only
be referred to at present.

The whole of the ingesta is not always absorbed — a large part is
carried off with the secretions which might still have served the purposes
of nutrition.

The residue is composed of — Ist What is refractory to the digestive
process, as corneous substances — certair; epidermic coverings, insoluble
phosphates, etc 2ndly. Substances which are expelled because not
digested; as when an animal is fed on fecula in excess, that only is
absorbed which is converted into sugar, whilst the remainder is voi«led
unchanged. The same is true of faity matt r in excess, which also
escapes in a condition very similar to that in which it entered.

What, then, is the reaction of tlie coecum, that some talk so much
of? The coecum, M. Bernard stated — and we saw experiments on a
dog which confirmed it — has an acid reaction, but no new digt-stive
powers. Some describe it as a second digestive stomach or cavity. The
reaction of the coecum is somt*timea alkaline ; t is depending upon the
excess of certain products of digestion, or certain kind-* o\' ft>od intro-
duced into the stomach. A superabundance of starch and sugar con-
sumed by an animal, is changed to actic acid, and, when it reaches the
coecum, of course presents an acid reaction. Exactly the reverse occurs
if the animal had been fed on azotized substance-^. The coeca of car-



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436 Bernard on the Abdomino- Renal Circulation.

Divorous animals, consequently, present an alkaline reaction which can
be reversed by altering the character of the diet.

The coecum is not, then, an organ of secondary digestion. The well
known phenomena of spontaneous decomposition which occurs there,
depend upon extrinsic causes. M. Bernard does not account for the
odour which characterizes this portion of the intestinal tube. The great
rariety in the size, and the absence even of the coecum in some animaisy
18 another strong argument to prove its comparative unimportance. In
the horse it is very large, and in the dog quite small.

All substances absorbed, which pass through the liver, do not go
directly to the general circulation. They seem to be arrested by this
organ.

Through the kidneys, also, many substances enter without makiog
the circuit of the general circulation. There appears to be a pecaliar
abdomino-renal circulation, by which Uie quality of urine is altered
independently of any influences derived from the circulation through
the heart. In many animals a great deal of fluid substances go directly
to the renal vein without reaching the liver. In almost all animals, witli
the exception of the mammifferous, there is a considerable amount of
substances ingested, which circulate through the kidneys without even
coming in contact with the lung.

In some animals the kidney is really an organ with functions, varying
considerably from that of others. A carnivorous animal, during diges-
tion, has the character of its urine materially altered in the proportioH ^
of its constituent. There being two species of normal urine — that secre-
ted by the veins, and that eliminated from the arteries — they must, of
course, vary with the ingesta.

M. Bernard, to test some of the changes which food of various kinds
undergoes during digestion, and to obtain some of the chyle of the
thoracis canal, placed a dog upon the table which had been fed on
mixed food, composed of starch, sugar, viands, fat, etc It was then
killed by passing a sharp pointed bistoury into the medulla oblongata,
and, urx)n examination, the intestinal canal presented the following pe-



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Bernard on the Abdomino- Renal Circulation, 437

porta (abdomiDO-renal circulation) and the general circulation,
which Taried under certain circunutances — as during the absence and
presence of food in the stomach — and which it is important to observe.

An animal which has, for a long time, been abstinent, receives a large
quantity of food in its stomach ; a draught is suddenly made upon the
Teoa porta, which differs from other veins in its not only carrying all
the blood of the mesenteraic veins, but it is also, at the same time^
diarged with the carrying of almost all the substances absorbed from
the intestines; in this respect resembling the pulmonary artery.

Now in some animals, as in horses for example, there are veins pass-
ing directly from the vena porta to the vena cava inferior ; and, when
the former is much swollen, a portion of its contents pass to the latter
without traversing the liver. So that just below the diaphragm is often
very much distended, on account of the accumulation. A very small
porUon of its contents pass to the heart ; the valves existing there
(preparations of which were exhibited) prevent it from descending, and
it is forced to reflow through the renal veins to the kidneys. ' So that,
indeed, the kidney is between two pressures ; and the secretion of urine
must depend somewhat upon whether the animal is or is not in full
digestion. The acid of the urine becomes alkaline during digestion,
and its secretion is much increased in quantity.

During this pressure upon the valves of the vena cava, of which we
have just spoken, the blood of the lower limbs goes by the vena azygios.
The latter in these animals (the horse, for example) is very large, to
compensate for the varying demands made upon it. After the hurry
of digestion is over, the vessels cease in a measure to expand, and the
blood then reflows along the vena cava, and finally gains the heart as
ordinarily. But we see from the above, that a certain quantity of ali-
mentary substances goes directly to the kidney, without reaching the
heart. And the same is true of man, in whom, though with shorter
intestines, it is less distinctly observed. M. Bernard was enabled to
study the process with more advantage in auimab with a larger and
longer intestinal tube. By this view we see in* what way the kidneys
are enabled to maintain a balance in the circulation.

If prussiate of potash is given to an animal during full digestion, it
is absorbed and passes through the hepatic and renal circulation, by
which it is eliminated ; a very small portion, if any, reaching the heart
A reverse condition takes place if another, which has fasted for some
time, is fed on the same substance ; the greater portion of it is received
mto the torrent of the circulation, by means of which it is conveyed to
distant parts of the system. This explains the variety in the action cf



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438 RuMPH on Malaria.

tbe same or a smaller doee of a poison, when received into the system
at different times ; in the one case quite a large quantity may be elimi-
nated with the urine, and rendered innocuous, when a much smaller
amount, swallowed on an empty stomach, would have been attended
with dangerous or fatal consequences.

Now, the physiological fact, that at certain digestive periods a larger
portion of the absorbed aliment passes to the kidney without reaching
the heart, receiver anatomical development in some animals in whom
the vessels, which contribute to this, are in more constant service, and
become proportionally enlarged. The renal veins have a very important
rdle to play, and one can witness, by making a small aperture into the
abdomen, the reflux through them. In the English race-horse they are
very much increased in size, from the constant rapidity with which the
circulation is often kept up. The same excessive development is
observed at the abattoirs^ among animals which have been worried or
run down ; in which case there is considerable hepatic engorgement,
with increase in the demands made upon the portal veins, together with
those contributing to tbe fiinctions of the kidney. [We know, also, that
if the vena porta is injected after death, it produces considerable expan-
sion on the liver ; being invested by the capsule of glisson, its walls are
not adherent to the liver like the hepatic vein, and thus admit of an
increase in size.]



Art. it. — Thoughts on Malaria^ and the onuses generally of Fever,
(Continued from the Charleston Medical Journal, Vol. 7, No. 6.) By
J. D. RuMPH, M. D., Orangeburg, S. C.

The editors of the Charieston Medical Journal, commenting on the
papers of Dr. LaRoche, on Malaria, as causative of our endemic fevers,
Ac, remark : ** That it appears at a juncture, when on the one handi
by some writers in the West, almost all our diseases are referred to ma-
laria as a cause, and on the other, its existence is denied by others, be"
cause it cannot be demonstrated chemically, microscopically, &c. — the
writers of the latter category seeming to forget that the existence and
operation of a cause can, in some instances, be proved by a process of
reasoning, the proof being as conclusive as if it resulted from a sight of
it" "Upon both classes," says the journalist, **Dr. LaRoche inflicts heavy
blows, whilst he himself is cased in a coat of mail." With the ut-
tnoBt deference and respect for the opinions of others, I shall not attempt



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KuMPU on Malaria. 439

to establish or disprove the title, whether we are hereafter to regard Dr.
LaRoche as the roodern Goliah, and whether there might not yet be
found a David who is able to discover a vulnerable point, by which tbis
great giant could be slain.

In my feeble judgment, however, I have not seen anything in the
Doctor's pieces to entitle him to anything beyond the consideration of a
mere man, though one calculated to enhance the dignity and honor of our
profession, and elevate its standard. Ilis blows come fast and heavy, but
nothing less than was expected, upon shoulders made broad to receive
them. I endeavoured to excite inquiry on the subject, and have obtain-
ed it; but proof, such as I desire, has not been given, and that Dr. L.^
and others who have given to malaria such unlimited and illimitable
scope, as the proximate cause of fever, have not afforded it incontesta-
bly to my mind, is now my purpose to show.

In 1852, when the yellow fever raged in Charleston very extensively,
and in Savannah pretty actively, the season offered no clue to its ap-
proachment, taking the data of others as a guide. April of this year
was cool and rainy. There were seven good rains, ot the 4tli, 5th, 1 Ith,
14th, l7th, 20th and 26th. It hailed on the I7tb and 18th. In May
the weather was pleasant and seasonable. We had eight rains : dd, 1 dth,
2dd, 26th, 29th, dOth and dlst; hail on the 29th May. In June, ^ve
rains, '/th, 21st, 24th, 27th and 30th. There was a very cool spell in
this month, from the 24th to the 27th. In July there was but one good
rain, which fell on the 16th — a sprinkle on the 21st. Then we bad no
rain until the 16th of August; ader this, we had frequent hard show-
ers, accompanied with much lightning and thunder, until October. This
month, and November, were dry, or rather the showers were very light
We had a small rain and a storm on the 10th October, and a sprinkle
on the 29th. November, it sprinkled on the 7th, 25th and dOth. In
December, we were deluged with rain, having had fourteen hard rains.
It was generally healthy with us this year, except during the latter part of
August, and the whole of September it was quite sickly — the fever
generally was of mild intermittent form : occasionally a few cases of
congestive and typhoid made their appearance. I shall make no fur-
ther remarks on this subject, having been led into it much fu^f-
ther than I intended, but will leave others to notice the breaches and
coincidences, and draw their own conclusions.

Lancisi announced the malaria doctrine as a primary cause of fever,
over a hundred and fifty years ago ; how many have adopted his views
since that period, it is impossible to say ; perhaps thousands. But this
shall not deter me from giving the results of my honest inquiries.



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440 RuMPU 071 Malaria,

I have not denied the agency of bad air, in some cases, in the prodnc-
tioo of disease ; but this is to be regarded as an exciting cause in all in-
stances, rather than as a remote or proximate cause. 8mall-pox and
mea>les belong especially to this category.

SchOnbien, a German of some notoriety, can see ample cause of fe-
ver in Ozone, an element produced from electricity under certain circum-
stances and conditions. A certain d<)gree of temperature favours the
electrical phenomenon, and when it is not given off in clouds, thunder
and rain, its effects are more sensibly felt, and prove more deleterious
to the animal system. We all feel depressed in very hot weather, es-
pecially of a dry season, and all have witnessed an increase of this de-
bility or oppression, about the rising of a large thunder cloud, when at-
tended by a calm. The atmosphere is now charged with the electric fluid,
and the consequences would be serious, did not the laws of nature
provide for its speedy exit by lightning, thunder, rain and winds, which
soon cool the air, whereby we are refreshed and invigorated, the enervating
means being dispersed. Then we have a direct proof of an agent of
deleterious import^ the existence and operation of which is so conclu-
sive, as not to require visual demonstration ; neither does it call for a met-
aphysical code of reasoning to establish its existence. You may call this
bad air, if you choose ; but let it not be understood to be that bad air, or
malaria, upon which so much stress is placed, as producing our endem-
ic fevers, pneumonia, and a hundred other diseases. I regard electricity,
its changes and effects, as one, if not the principal proximate cause of
fever ; whilst decomposed animal and vegetable matters, in a gaseous or
vaporous form, are likely to be a coincident, secondary and adjuvant
cause, but not at all necessary in most cases ; for the decay and decom-
position of a good many vegetable substances are not as injurious to
health, as the rotting piles of indigo weed, certain modes of making ma-
nure, <&c. This I have already spoken of in a former essay, but hope to
show more conclusively, in the course of the present one.

Gaspard and Leibig, I believe, were the first who spoke of collecting
ibis malaria, and pointed out the manner of examining the putrid mat-
ters of animals and vegetables in a gaseous form.

Subsequently, Dr. Hume, of Charleston, S. C, has given his views
and results on the subject, and thinks, from experiments he had made,
that he has discovered the malaria which produces yellow fever, in a
gaseous or vapourous condition by condensation. — See his essay on the
subject, in the Charleston Medical Journal, Vol. 6, No. 1, Jan., 1860.
It remains to be seen whether his discoveries are to be regarded as con-
clusive, and set down as such, or, like others, the results obtained are



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RuMPa on Malaria. 441

notbiDg less nor more than compounds of carbon, hydrogen, nitrogen,
ozjgen and sulphur, &c. If this is the case, I fear his discoveries mH
profit us but little. I very much suspect that he has been experiment-
ing with sulphuretted hydrogen, and carburetted hydrogen gases, con-
centrated in the places he found them. ^

His ideas, as regards the temperature of the atmosphere, the dew
point, the barometrical status, and the meteorlogical changes, are excel-
lent. For some time past I have endeavoured to give my attention to
these matters, particularly the dew point, and the thermoraetrical varia-
tions. The last year was a very dry ohe, particularly the early part ;
the dew point, in consequence, was very low, there being no rains in
April and May, except two or three small sprinkles on the 4th, 16th and
25th of April. The rains made a partial beginning on the 8th of June.
We had three rains in June ; fourteen in July ; ten in August, and six
in September ; and then none until the 20th of October. This period
embraces the sickly season. The dew point advanced very high as«oon
as the rainy season set in, and continued in this state until the first of
October, when it again fell pretty low, but not so low as it had been,
owing to cool nights. The weather was warm until the first of October,
when the mercury in the thermometer (Fahrenheit's) began to descend,
which it gradually continued to do until we had frost and ice, which was on
the 20th of November. I am sorry I did not make a table of this mat-
ter, or of these changes, but I hope my observations are sufficient for
practical purposes.

Now, it strikes me as something strange, that whilst the yellow fever
was raging in New Orleans, Mobile, A^c, and the cause attributed to the
changes attendant on a dry and hot season, other things' being favoura-
ble to the production of fevers, as assumed by the theory of Dr. Hume,
that we should have no yellow fever in Charleston the last season, and
so little intermittent fever in the Southern States generally, and in this
State particularly. This, in part, militates with the theory of Dr. Ilumo
and others. The same cause which produces yellow fever in cities, doea
not, therefore, produce intern^ittent fever in the country.

Yellow fever dies a natural death as soon as it reaches the pnre couu-



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442 RuMPH on Malaria.

Negroes are less liable to attacks of intermitteDt fever than whites,
as a general rule, but both classes are subject to it all their lives. I
have seen octogon^irians have it, and I have seen children at the breast
suffering with chill and fever. No respect is had to complexion, sex or
condition, the enciente female, the rheumatic, the syphilitic, the whoop-
ing cough patient, drc, are all subject to the fevers of this climate. The
present season bears so striking a resemblance, so far, to that of 1849, that
I am impressed with the idea that we are to look for similar results. It
will be recollected that that was the year the yellow fever prevailed ex-
tensively in the city of Charleston. We had a great deal of sickness
in the country also, that year ; our fevers befi:an early in June, spread
rapidly, were very pertinacious, and acquired some fatality ; they pre-
vailed till the first of December. The type was intermittent generally,
though we had more cases of typhoid fever than a year or two previous,
or since. We had a large snow on the 15th of April, and a freeze
every day after to the 2l8t. This year we have had several late cold
spells with ice. On the 27th March we had a fireeze, with plenty of
ice ^ inch thick ; and on the 3d and 18th of April, we had other freezes,
with ice as thick as that of March 27th. And at this time, 24th April,
it is cool for the season. I then remarked that we might look with
caution on the events of the approaching season. I will now direct at-
tention to the discoveries of Dr. Hume, which I have read with so much
pleasure, but with whose ideas I cannot agree entirely.

Chemistry has demonstrated the fact, that the compounds of carbon,
. hydrogen, sulphur, &c., are diffused in the atmosphere, and are delete-
rious in their influences, when we come in immediate contact with laige
amounts of either of them, not to say, however, that they are the causes of
fevers. This inclines me to believe, that the substance experimented
with, was a deposit of one or more of these chemical compounds to
which some organic matter may have been added ; possibly, some
putrescent animal substance was in or about the cellar of Mr. Gatchel, for
these cellars are not notorious for cleanliness, and he does not tell us
that he examined it very carefully, but says *' it was dark and damp, and
appeared clean." Alas ! how often are we deceived in appearances. It
would have been far more satisfactory, had he extended his experiments
to different parts of the city, in many cellars, and given his results in
each. Spring comes not with the singing of a single bird. Examina-
tion should be made in each summer and fall month; healthy as well as
unhealthy years should be considered. The electrical condition should
also be taken into consideration, in these unhealthy localities, and a
strict comparison made. Examinations and experiments should be



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RcjMPH on Malaria. 443

made iq cold weather. Then we shall learn Aomething more of these
things, that will be of substantial benefit In ray judgment, and I have
not formed it hastily, I have not seen anything in this connection to es-



Online LibraryBritish Association for the Advancement of ScienceCharleston medical journal and review → online text (page 50 of 98)