Anacharsis

“ Following up this opinion, and generalizing still more than the French pathologists, our author asserts that anasarca invariably consists in an inflammation of the cellular membrane of the body, with a serous effusion as its result. The accumulation, he continues, may be either idiopathic or symptomatic, and either general or local; occurring only under two forms, the one being of greater intensity that the other. In general, the disease derives all its importance from the nature of the remote cause. ”

“ Consequently, if there be none in cases of simple ascites, and if it only appears when anasarca supervenes, the only conclusion that may be drawn from these facts, is, that anasarca is the only form of dropsy, in which serum is absorbed, and passed off by the kidneys; and if there be a greater quantity discharged when anasarca is primary, it is only because the disease is more violent, and generally more extensive. ”

“ Does not cold occasion also ascites, which, in many cases, is regarded by every one as a local disease, sometimes terminating in anasarca? If so, why shall we regard anasarca, ending in ascites, as a general disease? The cases are analogous, and the action in both should not be explained differently. If the action of such a cause were really general, and extended to all parts of the body, then the effects should also be general, and the dropsy should be universal, which is very far from being always the case. ”

“ Of course in such an investigation the use of anacrusis in the types A and A1 should not be neglected. According to the presence or absence of anacrusis in the two hemistichs four different kinds of line may be distinguished:
1. Lines with anacrusis in both hemistichs. These are the most numerous of all, and are chiefly represented by the combinations of types A (A1) + A (A1) , A (A1) + B C1 (B C) :
2. Lines with anacrusis in the first section and without it in the second. These are almost exclusively represented by the combination A (A1) + A (A1) ; rarely by B C1 (B C) + A (A1) :
3. ”

“ When the original disease is a general anasarca, do not the cutaneous lymphatics always become paralytic at the same time with the cellular ones, by their greater sympathy with each other? and hence the paucity of urine, and the great thirst, distinguish this kind of dropsy?
3. In the anasarca of the lungs, when the disease is not very great, though the patients have considerable difficulty of breathing at their first lying down, yet after a minute or two their breath becomes easy again; and the same occurs at their first rising. ”

“ This difference appears to us to be very readily explained by the fact, that the disease in the former case, is more acute, and that the heart sympathises more actively with the irritated cellular tissue, than in the second case, when the disease is milder, or more gradual in its progress.
3d. It is also maintained, that when anasarca is idiopathic, there exists a large quantity of serum in the urine; and this is brought forward in order to distinguish these cases from local dropsies. But it is also admitted, that serum is found in the urine in cases of anasarca following ascites. ”

“ As it increases to a universal anasarca, there is difficulty of breathing, particularly after exercise, scanty urine, thirst, decay of strength, slow hectic{318} diminution of the natural heat, and more or less insensibility of the skin, which is dry. Sometimes the legs and thighs only are enlarged and distended to a monstrous magnitude; their skin bursts, ulcerates, or is irritated to erysipelatous inflammation. It is either complicated with ascites or hydrothorax, or beginning as œdema, and increasing to anasarca, it oozes through all the external cellular texture ”

“ In some cases of general anasarca, however, the disease is more severe; for sometimes the action of the heart and arteries is increased, the urine becomes loaded with serum, and there is thirst and other indications of general vascular excitement, similar to the state which was noticed, as producing effusion into the brain, or the other cavities of the body. ”

“ It is true that some writers, especially among the ancients, (for we can hardly class Portal among the moderns,) have spoken of the disease as arising occasionally from a plethoric state of the circulation, and enforced the necessity, under these circumstances, of venesection. This view of the pathology of anasarca, although leading in many instances to a successful practice, was, however, vague and often unsatisfactory. ”

“ Ionics.—These are formed by – –⏑⏑. When anacrusis is found—the usual form—the foot is often called Ionicus a minore (i.e. ⏑⏑– –) ; otherwise it is called Ionicus a maiore:—
κυανοῦν δ’ ὄμμασι λεύσσων φονίου δέργμα δράκοντος
πολύχειρ καὶ πολυναύτας Σύριόν θ’ ἅρμα διώκων (Persæ, 81 sq.) .
⏑⏑⁝– –⏑⏑|– –⏑⏑‖– –⏑⏑|– –ꞈ̄‖. A strange variant is ⏑–⏑–; the variation is called “anaclasis” (“breaking-up”) . Thus the above passage proceeds ”

“ The necessity which arises of tapping, where the effusion is very considerable, proves sometimes a farther cause, perhaps, of aggravating [Pg 93] the disease of the affected viscus, and either of renewing or extending the hydropic excitement, or of converting it into a higher or more destructive form of inflammation.
By most writers on dropsy, anasarca has been maintained to originate, in all instances, in debility, and to be curable only by a tonic and invigorating plan. ”

“ But, surely all this is far from proving, that primary anasarca is a general disease, and owes its origin to a primary arterial excitement of the whole system. When fever exists first, and terminates in dropsy, who has proved, that there existed no local irritation producing the fever, and that the hydropic irritation has not supervened by metastasis. ”

“ These patients, where the anasarca originates from, or commences in, the brain, have not other symptoms of diseased liver; have less difficulty of breathing at the beginning; and hold themselves more upright in their chair, and in walking. In this kind of dropsy I suspect the digitalis has less or no effect; as it particularly increases the absorption from the lungs. ”

“ Fig. 83.—Section of the stomach of an Anopheles, with cysts (oöcysts) of the malignant tertian parasite. (After Grassi) .
Copulation takes place in the stomach of the Anopheline (fig. 80, 16) . A microgamete penetrates a macrogamete and coalesces with it. The fertilized females elongate very soon and are called oökinetes or “vermicules” (figs. 80, 17; 82) . They penetrate the walls of the stomach, pierce the epithelium (fig. 80, 18, 19) , and remain lying between it and the superficial stratum (tunica elastico-muscularis) . ”

“ The essential difference between an anker or anchorite and a hermit appears to have been that, whereas the former passed his whole life shut up in a cell, the latter, although leading indeed a solitary life, wandered about at liberty. ”

“ The early blood forms are narrow and very motile. They increase in size and slacken in motility when they become about 20 microns long. S. cruzi is characterized by a very large blepharoplast. Dividing forms are never seen in the blood. The common site of multiplication is in the cells of the voluntary muscles and heart and also in the cells of the central nervous system, adrenals, and bone marrow. In these tissues the flagellate takes on a rounded form and undergoes binary division. Continued division converts the infected cell into a cyst. ”

“ There is seldom pain, and the patient seems to suffer chiefly from lassitude and extreme debility, which gradually increase; anasarca frequently supervenes; the functions of the organs affected are much impeded, or even altogether destroyed, and thereby the sinking of the powers of life is accelerated according to the viscera affected and the extent of the disease. Melanosis occurs most frequently in advanced life, though it is not confined to it ”

“ Permanent degeneration of the alimentary canal, of the heart, liver, kidneys, and blood-forming organs, may remain, and even prove fatal, although the primary cause is no longer present. The history and the absence of other sources of anæmia are all we may have to go upon for diagnosis in such circumstances.
Ankylostomiasis is sometimes confounded with beriberi, and vice versa. The presence of paretic and cardiac symptoms not accounted for by the moderate degree of anæmia in beriberi, and their absence in ankylostomiasis, suffice for diagnosis. ”

“ The fact that in an adult crab, many pairs of ganglia originally separate have become fused into a single mass, is a fact only second in significance to the differentiation of its alimentary canal into stomach and intestine. That in the higher Annulosa, a single heart replaces the string of rudimentary hearts constituting the dorsal blood-vessel in the lower Annulosa, (reaching in one species to the number of one hundred and sixty) , is a truth as much needing to be comprised in the history of evolution, as is the formation of a respiratory surface by a branched expansion of the skin. ”

“ Certain parts of the body seem less predisposed to hemorrhage. The central nervous system is often spared, notwithstanding extensive bleeding elsewhere, the meninges being somewhat more frequently involved. Hemorrhage of the lungs is also less common than might be expected, and it is probably true as Lasèque and Legroux suggested, that previous pulmonary disease, particularly tuberculosis, is an important predisposing factor.
Anasarca.—This comprises the second characteristic lesion found in scurvy at necropsy and was referred to in the earliest records of the disease. ”

“ The so-called white [leprosy] shows the difference between assimilation and adhesion, in the same way that the kind of dropsy which some people call anasarca clearly distinguishes presentation from adhesion. For, of course, the genesis of such a dropsy does not come about as do some of the conditions of atrophy and wasting, from an insufficient supply of moisture; the flesh is obviously moist enough,—in fact it is thoroughly saturated,—and each of the solid parts of the body is in a similar condition. ”

“ In animals, anthrax is also called charbon, splenic fever, or splenic apoplexy: in man, the name of malignant pustule is given to the sore at the point of accidental inoculation, and the name of woolsorter's disease is given to those cases of anthrax where the lungs are infected by inhalation of the spores of the bacillus anthracis. ”

“ They aggravate scorbutic affections, and accelerate often the disorganization of abdominal scirrhous parts, when too far advanced. They are in general dangerous in dropsy, though we have seen them succeed in a few cases of anasarca, without visceral indurations of too long standing. ”

“ In anasarca, an error is sometimes committed, especially by young practitioners, of estimating the degree of danger, and the necessity for active treatment, by the single consideration of the extent of the œdematous swelling. ”

“ In not a few cases, after immersion in fresh water, the animal continues to pulsate feebly for some little time; and, in all cases, irritability of the contractile tissues persists for a little while after spontaneity has ceased. The opalescence above referred to principally affects the manubrium, tentacles, and margin of the nectocalyx. While in fresh water the manubrium and tentacles of Sarsia are strongly retracted. ”

“ Hysteria, general debility, emaciation, sterility, various nervous affections, phthisis, in short, a perversion of almost any of the various physiological functions may be the direct result of anæmia. On the other hand, anæmia may be only a symptom or sequel of some other morbid condition—but of such cases I do not now speak. I have to do here only with those cases where anæmia is the primary and etiological of a group of symptoms, and where therefore it is to this that the treatment must be mainly directed. ”

“ The horse-flies have been definitely convicted of transferring the trypanosome of surra from diseased to healthy animals and there is good evidence that they transfer anthrax. The possibility of their being important agents in the conveyal of human diseases should not be overlooked. Indeed, Leiper has recently determined that a species of Chrysops transfers the blood parasite Filaria diurna. ”

“ As direct inoculators, biting or piercing species may take up from a diseased man or animal, germs which, clinging to the mouth parts, are inoculated directly into the blood of the insect's next victim. It it thus that horse-flies may occasionally transmit anthrax. ”

“ Anaximander held at least one theory which, as vouched for by various copyists and commentators, entitles him to be considered perhaps the first teacher of the idea of organic evolution. According to this idea, man developed from a fishlike ancestor, "growing up as sharks do until able to help himself and then coming forth on dry land." (1) The thought here expressed finds its germ, perhaps, in the Babylonian conception that everything came forth from a chaos of waters. ”

“ The cephalic ganglia are large, and lie over the digestive system, but the nerve-cords are separated throughout. The Nemer teans are chiefly dioecious, and the products of their sexual organs, which are developed in the form of a series of sacs on each side between the muscular wall of the body and the digestive canal, find exit by lateral pores, the contents of the male organs being often vented in clouds, as in Hermella, The young sometimes undergo a metamorphosis, e.g., the Pylidium-development of certain Anopla. ”

“ That increase of structure apart from increase of size, is here a cause of declining agamogenesis, we may see in the contrast between the simple Hydra and the compound Hydroids. These last, along with more-differentiated tissues, show us a gemmation which does not go on all over the body of each polype, and much of it does not end in separation.
It is, however, among the Annulosa that progressing organization is most conspicuously operative in diminishing agamogenesis. The segments or “somites” composing an animal belonging to this class, are primordially alike ”