Page:EB1911 - Volume 27.djvu/969

 In the mature foetus the fluid brought from the placenta by the umbilical vein is partly conveyed at once to the vena cava ascendens by means of the ductus venosus and partly flows through two trunks that unite with the portal vein, returning the blood from the intestines into the substance of the liver, thence to be carried back to the vena cava by the hepatic vein. Having thus been transmitted through the placenta and the liver, the blood that enters the vena cava is purely arterial in character; but, being mixed in the vessels with the venous blood returned from the trunk and lower extremities, it loses this character in some degree by the time that it reaches the heart. In the right auricle, which it then enters, it would also be mixed with the venous blood brought down from the head and upper extremities by the descending vena cava were it not that a provision exists to impede (if it does not entirely prevent) any further admixture. This consists in the arrangement of the Eustachian valve, which directs the arterial current (that flows upwards through the ascending vena cava) into the left side of the heart, through the foramen ovale—an opening in the septum between the auricles—whilst it directs the venous current (that is being returned by the superior vena cava) into the right ventricle. When the ventricles contract, the arterial blood contained in the left is propelled into the ascending aorta, and supplies the branches that proceed to the head and upper extremities before it undergoes any further admixture, whilst the venous blood contained in the right ventricle is forced into the pulmonary artery, and thence through the ductus arteriosus—branching off from the pulmonary artery before it passes to the two lungs—into the descending aorta, mingling with the arterial currents which that vessel previously conveyed, and thus supplying the trunk and lower extremities with a mixed fluid. A portion of this is conveyed by the umbilical arteries to the placenta, in which it undergoes the renovating influence of the maternal blood, and from which it is returned in a state of purity. In consequence of this arrangement the head and upper extremities are supplied with pure blood returning from the placenta, whilst the rest of the body receives blood which is partly venous. This is probably the explanation of the fact that the head and upper extremities are most developed, and from their weight occupy the inferior position in the uterus. At birth the course of the circulation undergoes changes. As soon as the lungs are distended by the first inspiration, a portion of the blood of the pulmonary artery is diverted into them and undergoes aeration; and, as this portion increases with the full activity of the lungs, the ductus arteriosus gradually shrinks, and its cavity finally becomes obliterated/ At the same time the foramen ovale is closed by a valvular fold, and thus the direct communication between the two auricles is cut off. When these changes have been accomplished, the circulation, which was before carried on upon the plan, of that of the higher reptiles, becomes that of the complete warm-blooded animal, all the blood which has been returned in a venous state to the right side of the heart being transmitted through the lungs before it can reach the left side or be propelled from its arterial trunks; After birth the umbilical arteries shrink and close up and become the lateral ligaments of the bladder, while their upper parts remain as the superior vesical arteries. The umbilical vein becomes the ligamentum teres. The ductus venosus also shrinks and finally is closed. The foramen ovale is also closed, and the ductus arteriosus shrivels and becomes the ligamentum arteriosum.

The blood vessels are supplied with constrictor and dilator nerve fibres which regulate the size of the vascular bed and the distribution of the blood to the various organs. The arteries may be compared to a high pressure main supplying a town. By means of the vaso-motor nerves the arterioles (the house taps) can be opened or closed and the current switched

on to or off any organ according to its functional needs. If all the arterioles be dilated at one and the same time, the aortic pressure falls, and the blood taking the pathways of least resistance, gravitates to the most dependent parts of the vascular system, just as if all the taps in a town were opened at once the pressure in the main would fail, and only the taps in the lower parts of the town would receive a supply. The discovery of the vaso-motor nerves is due to Claude Bernard (1851). He discovered that by section of the cervical sympathetic nerve he could make the ear of a rabbit flush, while by stimulation of this nerve he could make it blanch. Claude Bernard had the good fortune to make the further discovery that stimulation of certain nerves, such as the chorda tympani supplying the salivary gland, produces an active dilatation of the blood vessels. The vaso-constrictor fibres issue in the anterior spinal roots, from the second thoracic to the second lumbar root, and pass to the sympathetic chain of ganglia. The fibres are of small diameter, and probably arise from cells situated in the lateral, horn of the grey matter of the spinal cord. They each have a cell station in one other ganglion and proceed as post-ganglionic fibres to the cervical sympathetic, to the mesenteric nerves and to the nerves of the limbs. Nicotine paralyses ganglion cells, and by applying this test to the various ganglia the cell stations of the vaso-constrictor fibres supplying each organ have been mapped out. The vaso-dilator fibres have not so restricted an origin, for they issue in the efferent roots in all parts of the neural axis. The two kinds of nerves, although antagonistic in action, end in the same terminal plexus which surrounds. the vessels. The presence of vaso-dilator fibres in the common nerve trunks is masked, on excitation, by the overpowering action of the vaso-constrictor nerves. The latter are, however, more rapidly fatigued than the former, and by this and other means the presence of vaso-dilator fibres can be demonstrated in almost all parts of the body. The nervi-erigentes to the penis and the chorda tympani supplying the salivary glands are the most striking examples of vaso-dilator nerves. The vaso-dilator nerves for the limbs issue in the posterior spinal roots (Bayliss). The posterior roots contain the afferent nerves (touch, pain, &c.). Excitation of these fibres causes reflexly a rise of blood pressure directly, a vaso-dilatation of the part the nerves supply. Thus it is assured that the irritated or injured part receives immediately a greater supply of blood. The vaso-motor centre exerts a tonic influence over the calibre of the arterial and portal systems.

Much labour has been done. since to determine the origin and exact distribution of the vaso-motor nerves to the various organs, and the reflex conditions under which they come normally into action, and, as the fruit, our knowledge of these inquiries has come to a condition of considerable exactness. This knowledge is of great practical importance to the physician, and it is worth noting that it has been obtained entirely by experiment on living but anaesthetized animals. No dissections of the dead animal could have informed us of the vaso-motor nerves. Vaso-motor effects can be studied by (1) inspection of the flushing or blanching of an organ; (2) measuring the venous outflow; (3) recording the pressure in the artery going to and the vein leaving the organ; (4) observations on the volume of an organ. To make these observations, the organ is enclosed in a suitable air-tight box or plethysmograph, an opening being contrived for the vessels of the organ to pass through so that the circulation may continue. The box is filled with air or water and is connected with a recording tambour (see fig. 18).

The chief effects of vaso-constriction are an increased resistance and lessened flow through the organ, diminished volume and tension of the organ, the venous blood issues from it darker in colour and the pressure rises in the artery and falls in the vein of the organ, and its temperature sinks. Lastly, if a large area be constricted the general arterial pressure rises.

The centre is situated in the spinal bulb beneath the middle of the floor of the fourth ventricle. The tone of the vascular system is not disturbed when the great brain and mid brain is destroyed as far as the region of the pons Varolii, but as soon as the spinal bulb is injured or destroyed the arterial pressure falls very greatly, and the animal passes into the condition of surgical shock if kept alive by artificial respiration. Painting the floor of the fourth ventricle with a local anaesthetic, e.g. cocaine, has the same lowering effect on the blood pressure. Division of the cervical spinal cord or of the splanchnic nerves lowers the blood pressure greatly. The one lesion cuts off the whole body, the other the abdominal organs from the tonic influence of the centre. The fall of pressure is due almost entirely to the pooling of the blood in the portal veins and vena cava inferior. On the other hand, electrical excitation of the lower end of the divided cord or splanchnic nerves raises the pressure by restoring the vascular tone. If an animal be kept alive after division of the spinal cord in the lower cervical region, as it may be, for the phrenics, the chief motor nerves of respiration, come off above this region, it is found that the vascular tone after a time becomes restored and the condition of shock passes away. By no second section of the spinal cord can the general condition of shock be reproduced, but a total obstruction of the cord once more causes a general loss of the vascular tone. From the experimental result, so obtained, it is argued that subsidiary vaso-motor centres exist in the spinal cord, and there is evidence to show that these centres may be excited reflexly. After the lumbar cord has been destroyed the tone of the vessels of the lower limbs is recovered in the course of a few days. In this case the recovery is attributed to the ganglionic and nervous structures which are intercalated between the spinal cord and the muscular walls of the blood vessels. There are thus three mechanisms of control, the bulbar centre influenced particularly by the visual, auditory and vestibular nerves. the spinal centres and the peripheral ganglionic structures.

The vaso-motor centre is reflexly excited by the afferent nerves, and its ever-varying tonic action is made up of the balance of the “pressor” and “depressor” influences which thus reach it, and from the quality of the blood 'which circulates through it. Pressor effects, i.e. those causing increased constriction and rise of arterial pressure, may be produced by stimulating the central end of almost any afferent nerve, and especially that of a cutaneous nerve. Depressor effects are always obtained by stimulating the depressor nerve, and may be obtained by stimulating the afferent nerves under special conditions. That these reflex vaso-motor effects frequently occur is shown by the blush of shame, the blanching of the face by fear, the blanching of the skin by exposure to cold and the flushing which is produced by heat. The rabbit’s ear blanches if its feet are put into cold water. The vaso-motor mechanism is one of the most important of those mechanisms which control the body heat, Stimulation of the nasal mucous membrane causes flushing of the vessels of the head, constriction elsewhere and a rise of arterial pressure. Food in the mouth, or even the sight or