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Now, without denying that, therapeutically, there may be something in this mode of reasoning, which perhaps may explain why the stomach of one person agrees with one oil, and another with a different one; it is not necessary to suppose that the different organs and glands of the economy are affected by the various substances of which the oil is composed. Physiology tells us that if we can succeed in stimulating the first stages of nutrition in scrofulous cases, the subsequent ones will be necessarily forced into renewed action. Make good chyle, and good blood and tissues will follow. In this case especially, c'est le premier pas qui coute. But be this as it may, the introduction of cod-liver oil into medical practice is now universally recognised to have been productive of great good, and in the works of MM. Tauftlieb and De Jongh will be found an excellent resumé of the class of cases, with examples in which it has been found most beneficial. Although we have only alluded to Dr Black's observations in reference to the mode of action of oil, we can recommend his brochure as a very excellent one on the subject of which it treats. The figures in the plate he has given will be recognised by every histologist as being well executed and true to nature.
Epilepsy and other Affections of the Nervous System which are marked by Tremor, Convulsion, or Spasm; their Pathology and Treatment. By CHARLES BLAND RADCLIFFE, M.D., Assistant Physician to the Westminster Hospital, etc. London, 1854. 8vo, pp. 144. Eutherapeia : or, an Examination of the Principles of Medical Science, with Researches in the Nervous System. By ROBERT GARNER, Surgeon to the North Staffordshire Infirmary, etc. London,
1855. 8vo, pp. 282. On the Pathology of Delirium Tremens ; and its Treatment without
Stimulants or Opiates. By ALEXANDER PEddie, M.D., Edin. Edinburgh, 1854. 8vo, pp. 51.
(Continued from p. 245.)
By epilepsy we understand a disease of the nervous system occurring in paroxysms, in which consciousness is suspended, whilst the muscles are thrown into spasms more or less general. The abolition of cerebral, and the excitation of motor functions have always rendered the pathology of the disease a matter of obscurity, and its paroxysmal character, in the intervals of which, all the functions of the body frequently proceed without change, have tended still further to perplex the scientific inquirer. The work of Dr Radcliffe has for its object the elucidation of the epileptic phenomena, and the improvement of their medical management. Hitherto it NEW SERIES.-NO. IV. APRIL 1855.
has been supposed that sometimes the disease may depend upon an increase, and at others upon a diminution of the vital powers of the system. According to Dr Radcliffe, it is always connected with debility, and always requires a tonic and stimulating treatment. In arriving at this conclusion, he has been led into a lengthened physiological argument which displays great ingenuity and very extensive knowledge of the physiology and pathology of the nervous system, a branch of inquiry, indeed, which all those who have cultivated it, know has been pursued with great zeal and success by Dr Radcliffe. A rather copious analysis of his work, therefore, is required to do his argument justice, as well as to place the modern views of epilepsy fully before our readers :
In the first place the author examines muscular contraction as manifested in ordinary muscle, in the coats of vessels, and in the heart.
The contraction which is manifested in ordinary muscle cannot he thinks, be regarded, as the result of any kind of stimulation, for the following reasons :- An involuntary muscle is much more sparingly supplied with nerves than a voluntary muscle. An involuntary muscle is much more disposed to contract than a voluntary muscle. In other words, that muscle is most disposed to contract which is least supplied with nervous influence; and hence it follows, or appears to follow, that nervous influence is not necessary to contraction.
An involuntary muscle has far fewer blood vessels than a voluntary muscle, and hence blood does not seem to be necessary to contraction, for the muscle which receives the least quantity of blood is most disposed to contract. The muscles of a hybernating animal are more prone to contract during the hybernating than during the active state, and yet the circulation at this time is so low as to be barely consistent with life. The muscles of a reptile are more prone to contract than the muscles of a mammal, and yet these muscles are distinguished chiefly by their paleness, that is, by their want of blood. Rigor mortis occurs when the blood is stagnant and dead, and passes off repeatedly (as has been shown by the experiments of M. Brown-Séquard) when new blood is injected. All these facts are opposed to the idea that the blood is necessary to contraction.
Some of the investigations of MM. Dubois Reymond and Matteucci are equally opposed to the idea that muscular contraction is stimulated by electricity. These investigations show :—That there is a current of natural electricity in a muscle when at rest. That the evidences of this current disappear during contraction. That contraction is immediately provoked by the passage of a current of artificial electricity which opposes and neutralizes the natural current; but that contraction is not provoked by the artificial current, when it coincides with and intensifies the natural current, until the circuit is broken and the former suspended.
Nor is it by any means certain that muscular contraction is stimu- / lated by contact. Instead of exciting the stomach to contract, the food accumulates, and the stomach expands, until the appetite is satisfied, and contraction happens when the stimulus connected with the molecular changes of digestion is at an end. Instead of exciting the uterus to contract, the germ increases in size, and the womb expands proportionately, and contraction happens when (apparently) the stimulus of increasing growth is at an end. It is not even certain that a needle stimulates contraction. The muscle does not always contract under these circumstances; and when it does, the contraction may possibly be due to the discharge of electricity previously present in the muscle. The experiments of M. Dubois Reymond prove the existence of such a discharge; and the analogy between the structure of muscle and of the electrical organ of the torpedo, and between the circumstances attending the production of contraction on the one hand and of discharge on the other, are in favour of this supposition. The facts, moreover, which have just been mentioned respecting the action of nervous influence, blood, and electricity, are opposed to the idea that the contraction is stimulated by the needle.
It is the same with regard to other agencies. It is cold (which is the privation of heat), and not heat, which favours contraction. It is darkness, and not light, which favours contraction in the irritable cushions of the sensitive plant; and it is the same in the iris, for it is more easy to suppose that the iris expands under the stimulus of light, and that the pupil is closed in this manner, than that it is drawn out by the contraction of sphincter fibres, which have no existence. This explanation is supported by the authority of Bichât; it equally accounts for the phenomena ; and it harmonises with the known influence of light upon the sensitive plant. Again, it is carbonic acid, and not oxygen, which favours contraction in the muscular fibres of the air-passages. Oxygen, indeed, seems to provoke the very opposite of contraction, for under its influence the air-passages dilate and fill with air. Again, other non-stimulating agencies, such as opium or strychnia, favour contraction; and other stimulating agencies, such as alcohol or æther, oppose contraction.
It appears, therefore, that muscular contraction, as manifested in ordinary muscle, is due to the withdrawal of the vital or physical stimulation which was previously present in the muscle, and not to the impartation of any new stimulation. It further appears that there is no reason why this contraction may not be due to common molecular attraction--that is, to the law of gravitation. It is, indeed, quite possible that the semi-gaseous constitution of the muscle may allow the particles of the muscle to recede or approach to a much greater degree under the presence or absence of heat or any other stimulus, ihan is allowed by the physical constitution of a metal or any fixed solid. It is quite possible that this should be the case, for so unstable are the affinities of the muscular particles, that (for the most part) these affinities cease to operate immediately after
death, and the particles become resolved into their constituent
A similar conclusion arises from a consideration of muscular contraction, as manifested in the coats of vessels. “Joy flushes the skin and fear blanches it; in other words, the superficial capillaries expand when the nervous energy is exuberant, and shrink when it is deficient. When the blood is rich and stimulating, as in plethora, the vessels are red and full; when it is poor and watery, as in anæmia, they are shrunk and empty.” When the hand is held to the fire, it becomes flushed; when exposed to cold it becomes pale. These phenomena appear to be utterly inconsistent with the idea that the muscular contraction of the vessel is caused by nervous influence, by blood, or by heat ; and other phenomena are not less so. Arguing from the remarkable expansion which is caused by heat in the dartos and in the ordinary subcutaneous cellular web, it is also supposed that the heat and other stimuli acting upon the vessels must cause a greater degree of expansion in the coats of the vessel (which contain a good deal of cellular tissue) than in the fluid contents of the vessel (which consist chiefly of water); that vacua must thus be left between the coats and the contents; and that movements must result from the blood passing to fill these vacua, which movements are altogether independent of the heart. If, therefore, the hand be held to the fire, the vacua thus resulting from the excess of expansion in the vessels must necessitate a flow of blood to the part.
The muscular contraction of the heart is equally inexplicable on the supposition that it is the result of stimulation.
“The fact that the heart remains distended with blood durirg a full half of the time occupied in its rhythm, is a strong argument that the blood does not excite the ventricular systole. The histories of plethora and anæmia are to the same effect. In plethora the pulse is full and slow ; in anæmnia, empty and quick. In the one case, the heart fills to distension with rich blood, and the systole is deferred ; in the other case, the heart takes in a small quantity of poor, unstimulating blood, and expels it immediately. The facts are the very opposites of what they ought to be if the blood excited contraction, for then there should be a sinall quick pulse in plethora, and a full slow pulse in anærnia. But they are just what they ought to be, if the blood provokes the heart to dilatation by its stimulant properties, for then the heart ought to dilate most, and the dilatation to continue longest, when the blood is rich and warm, as in plethora.”—P. 33.
Upon attending more particularly to the phenomena of the heart's action, it appears still more improbable that the ventricular systole is caused by stimulation of any kind—and of the blood particularly. At the systole the oxygenated arterial blood rushes through the coronary arteries into the coats of the heart; there it remains until it has given up its arterial and stimulating properties; and then the systole returns. This is the simple fact. The seeming probability is, therefore, that the diastole is stimulated by the blood, and not the systole ; and this probability is increased by the circumstance that it affords a clue to the rhythm of the heart.
Thus, according to the author, contraction of ordinary inuscles, of the coats of vessels, and of the heart, is everywhere manifested under the same circumstances, and this contraction is due to the unresisted molecular attraction of the muscle upon the suspension of that stimulation which is synonymous with life. In this way muscular contraction, instead of being a phenomenon peculiar to vitality, is an effect of the grand law of gravitation. In this way, the three grand and hitherto inexplicable phenomena of physiology
-muscular contraction, the movement of the blood in vessels, independently of the heart and the action of the heart-receive a single and physical explanation.
The pathology of the disorders in which muscular contraction is in excess—" epilepsy and other affections of the nervous system which are marked by tremor, convulsion, or spasm,” admits of being explained in far fewer words than the physiological premises, though the statement of all the facts upon which the pathology is based occupies a much wider space in the volume itself. The topics successively considered are epilepsy, affections allied to epilepsy, periodicity, and treatment.
In epilepsy, the condition of the circulation is habitually one of great depression. The plethora of the butcher is never met with, and any vascular fulness, if such exists, is mere venous congestion. This depression is aggravated before the fit; and during the fit the condition is either one of asphyxia or syncope. If inflammation, or true fever, chance to be developed, so surely are the convulsions of epilepsy banished for the time. These conclusions are warranted by all the facts of the case. With this condition of the circulation an active condition of the nervous system is incompatible, and this is in accordance with the actual symptoms. Sense and intellect are completely obliterated during the fit, and at all times they are under a cloud, or if the torpor is occasionally broken by maniacal or other excitement, the patient is for the time relieved from bis fits. The condition of the muscles is always wanting in tone. The several causes inducing the fits are always exhausting, and not exciting, in their character. In a word, there is every reason to believe that the muscles of the epileptic contract excessively (as might be expected from the premises) because they are less stimulated than they ought to be, and not for a contrary reason.
In affections allied to epilepsy, whether these be marked by tremor, convulsion, or spasm, the same conclusions are arrived at. The condition of the circulation during the paroxysm is still one of asphyxia or syncope, or one tending to asphyxia or syncope. Inflammation and true fever are utterly uncongenial with any form of tremor, convulsion, or spasm. Thus, rigor precedes fever, and again succeeds it as subsultus, but it never accompanies fever. Convulsion often takes the place of rigor, or subsultus, but it never occurs in the intermediate hot stage. The spasm of hooping-cough disappears if pneumonia or bronchitis are developed, and returns again