Edmund Owen

“ Closer investigation in recent times has, however, brought out the very striking fact that, if oxidation be measured in terms of energy liberated by it in the body, it makes but little difference, other things being equal, whether the animal is fasting or not. If more proteid or carbohydrate is oxidized at one time, correspondingly less fat is oxidized, but the total energy liberated as heat, &c., in the body is about the same, unless the diet is very excessive, when there is a slight increase of oxidation. ”

“ Synovitis.—When a joint has been injured, inflammation occurs in the damaged tissue; that is inevitable. But sometimes the attack of inflammation is so slight and transitory as to be scarcely noticeable. This is specially likely to occur if the joint-tissues were in a state of perfect nutrition at the time of the hurt. But if the individual or the joint were at that time in a state of imperfect nutrition, the effects are likely to be more serious. As a rule, it is the synovial membrane lining the fibrous capsule of the joint which first and chiefly suffers; the condition is termed synovitis. ”

“ Hence we may distinguish two types of respiration, the costal and the abdominal, according to the preponderance of movement of one or the other part of the body wall. In forced respiration the type is costal in both sexes, and so it is also in sleep. The cause of this difference between men and women has been variously ascribed (a) to constriction of the chest by corsets in women, (b) to a natural adaptation to the needs of child-bearing in women, and (c) to the greater relative flexibility of the ribs in women permitting a wider displacement under the action of the inspiratory muscles. ”

“ Rheumatic tetanus is as unreal a disease as that just mentioned. The germs themselves do not wander from the wound to multiply in the blood as in infecting diseases, but remaining at the wound elaborate a terribly poisonous substance (a toxin) which makes its way along the nerve-trunks to the spinal cord. Even prompt amputation, however, is likely to prove ineffectual as regards cure, for the germs in the wound have in this growth set free so virulent a poison (toxin) that the nerves of the voluntary muscles all over the body are hopelessly under its influence. ”

“ But experience has amply shown that in the early stages of the disease, mercury, at least for the present, is the only drug on which reliance can be placed. Guaiacum was at one time extensively used, and somehow or another sarsaparilla acquired a bubble reputation; but the practical surgeon of to-day ignores these drugs in the treatment of syphilis. Still, mercury must be prescribed with great judgment. For a man worn out by alcoholic or other excesses, or with health broken down by tuberculosis or other exhausting disease, mercury must be given with great caution. ”

“ Unlike whooping-cough, smallpox or pleurisy, syphilis is not a disease which, left untreated, cures itself in the course of time. Syphilis is a disease which peculiarly calls for treatment, and that treatment, to be effectual, must be prolonged. To: promote the healing of an ulcer, or to get rid of a cutaneous eruption, the result of syphilis, is not to treat syphilis. It is merely to free the patient of a symptom of the disease. ”

“ Rheumatoid Arthritis, or chronic Osteo-arthritis, is generally found in persons beyond middle age; but it is not rare in young people, though with them it need not be the progressive disease which it too often is in their elders. It is an obscure affection of the cartilage covering the joint surfaces of the bones, and it eventually involves the bones and the ligaments. A favourite joint for it is the knee or hip, and when one large joint is thus affected the other joints may escape. But when the hands or feet are implicated pretty nearly all the small joints are apt to suffer. ”

“ The relative frequency of fracture of the bone and dislocation of the joint depends on the strength of the bones above and below the joint relatively to the strength of the joint itself. The strength of the various joints in the body is dependent upon either ligament or muscle, or upon the shape of the bones. In the hip, for instance, all three sources of strength are present; therefore, considering the great leverage of the long thigh bone, the hip is rarely dislocated. ”

“ If we were to perform the same operation of removing a part of the chest wall in a body not first frozen we should find, on the other hand, that the contents of the thorax are not by any means in such circumstances bulky enough to fill up the space provided for them. If we were to measure the organs carefully we should find that those which are hollow and whose cavities communicate with the regions outside the thorax are all larger in the frozen corpse than in that which was not frozen. ”

“ Hence the variable condition of the air as regards temperature, degree of moisture, and density, is liable to produce directly various changes in the lungs, or to predispose them to disease; and the contamination of the air with various pathogenic germs and irritating particles in the shape of dust, is a direct source of many lung affections. ”

“ Thus a fire burns the faster the more air is supplied, and the higher the percentage of oxygen in the air. It was for long believed that in the living body also the rate of oxidation must vary according to the oxygen supply. It has been found, however, that this is not the case. Provided that a certain minimum of oxygen is present in the air breathed, or in the blood supplied to the tissues, it is, practically speaking, indifferent whether the oxygen supply be increased or diminished: only a certain amount is consumed. ”

“ The teaching of modern surgery is that a small incision into the abdomen and a prompt withdrawal of the invaginated piece of bowel can be trusted to do all that, and more than, infection can effect, without blindly risking a rupture of the bowel. It is certain that when the surgeon is unable to unravel the bowel with his fingers gently applied to the parts themselves, no speculative distension of the bowel could have been effective. ”

“ The poisonous action of carbon monoxide can be abolished by placing the animal exposed to it in oxygen at an excess pressure of about an atmosphere. The reason for this is that, in consequence of the increased partial pressure of the oxygen, the amount of this gas in free solution in the blood is greatly increased in accordance with Dalton's law, and becomes sufficient to supply the tissues with oxygen quite independently of the haemoglobin. Even at ordinary atmospheric' pressure the extra oxygen dissolved in the blood when pure oxygen is breathed is of considerable importance. ”

“ Looking at what is known with regard to respiratory oxidation, we see that what is most striking and most characteristic in it is its tendency to persist-to remain on the whole at about a normal level for each animal, or each stage of development of an animal. ”

“ The foregoing, facts enable us to understand the regulation of breathing under normal conditions. The pressure of carbon dioxide in the alveolar air evidently determines that of the carbon dioxide in the arterial blood, and the latter in its turn determines the carbon dioxide pressure in the respiratory centre, which is very richly supplied with blood. The centre itself is extremely sensitive to the slightest increase or diminution in carbon dioxide pressure; and thus it is that the alveolar carbon dioxide pressure is so important. ”

“ But if chronic disease lingers in the joint of a child or young person, the probability of its being under the influence of tuberculous infection must be considered. In such a case prolonged and absolute rest is the one thing necessary. If the disease be in the hip, knee, ankle or foot, the patient may be fitted with an appropriate Thomas’s splint and allowed to walk about, for it is highly important to have these patients out in the fresh air. If the disease be in the shoulder, elbow, wrist or hand, a leather or poro-plastic splint should be moulded on, and the arm worn in a sling. ”

“ Syphilis and Marriage.—The question as to how soon it would be safe for a person with secondary syphilis to marry is of extreme importance, and the disregard of it may cause lasting mental distress to the parent and permanent physical injury to the offspring. A man who finds himself to be the subject of secondary syphilis when he is engaged to be married would do well honourably to free himself from responsibility. But should a person who has been under regular and continuous treatment desire to marry, consent may be given when he has seen no symptoms of his disease for two full years. ”

“ In some people this movement is hardly perceptible unless breathing be heavy or laboured. As the air passes at the back of the throat behind the soft palate it causes the velum to wave very gently in the current; this is a purely passive movement. If we look at the glottis or opening into the larynx during respiration, as we may readily do with the help of a small mirror held at the back of the throat, we may notice that the glottis is wide open during inspiration and that it becomes narrower by the approximation of the vocal chords during expiration. ”

“ All of these substances contain carbon, hydrogen and oxygen in known, though different, proportions, and the former also contains a known amount of nitrogen and a little sulphur. Nitrogen is constantly leaving the body as urea and other substances in the urine and faeces; and a small but easily measurable proportion of carbon passes off in the same manner. The rest of the carbon passes out as carbon dioxide in respiration. Now carbohydrates and fats are oxidized completely in the body to carbon dioxide and water. ”

“ In rare cases the germs find their way to the pleura or pericardium, setting up an inflammation which may even end fatally.
For a man to marry whilst there is the slightest risk of his still being the subject of gonorrhoea would be to subject his wife to the probability of infection, ending with chronic inflammation of the womb or of septic peritonitis. Yet it is often extremely difficult to say when a man is cured. That there is no longer any discharge does not suffice to show that he has ceased to be infective. ”

“ There is often a good deal of heat of the surrounding skin and of pain accompanying the synovitis. In the case of a healthy individual the effects of a sprain may quickly pass off, but in a rheumatic or gouty person chronic synovitis may obstinately remain. In a person with a tuberculous history, or of tuberculous descent, a sprain is apt to be the beginning of serious disease of the joint, and it should, therefore, be treated with continuous rest and prolonged supervision. In a person of health and vigour, a sprained joint should be at once bandaged. ”

“ Air is brought into the lungs by the movements of breathing (see above, Movements of Respiration) . Oxygen from this air passes through the delicate lining membrane of the air-cells of the lungs into the blood, where it enters into loose chemical combination with the haemoglobin of the red corpuscles (see Blood) . In this form it is conveyed onwards to the heart, and thence through the arteries to the capillaries, where it again parts from the haemoglobin, and passes through the capillary walls to the tissues, where it is consumed. ”

“ If we compare different warmblooded animals, we find that the rate of oxidation is relatively to their weight far higher in the smaller ones. In a mouse-or small bird, for instance, the rate is about twenty times as great as in a man. The difference is in part due to the fact that the smaller an animal is the greater is its surface relatively to its mass, and consequently the more heat does it require to keep up its temperature. The smaller animal must therefore produce more heat. Even in cold-blooded animals, however, oxidation appears to be more rapid the smaller the animal. ”

“ Old tubercular glands in the abdomen, neck and elsewhere, and tuberculous disease of bones or joints, are common sources whence tubercle bacilli may become absorbed, and occasion a general dissemination of miliary tubercles in which the lungs participate. Where the source of infection is an old tuberculous bronchial gland or a focus of old tubercle in the lung, the pulmonary organs may be the only seat of- the development of miliary tuberculosis for a time; but even then, if life is sufficiently prolonged, other parts of the body become involved. ”