Chapter VII · OF THE INFLUENCE OF THE DEATH OF THE LUNGS OVER THAT OF THE BRAIN.
F. Gold translation
CHAPTER VII. OF THE INFLUENCE OF THE DEATH OF THE LUNGS OVER THAT OF THE BRAIN.
We have just seen, that in asphyxia, the movements of the heart are paralyzed, because its fleshy fibres are penetrated with venous blood. This fact should indicate the same to be the case with reference to the action of the brain. It is indubitably proved by experiment.
Whatever be the manner in which the pulmonary functions are interrupted, it is always the interruption of the chemical changes, which troubles the functions of the brain.[91] What I have said upon this point with respect to the heart, is exactly applicable to the cerebral mass: I shall not repeat it. It remains to shew by experiment, and the observation of diseases, that when the chemical functions of the lungs are put a stop to, it is the black blood which interrupts the action of the brain and that of the nervous system. In the first place let us examine our experiments.
I first began by transfusing into the brain of an animal, the arterial blood of another, that this essay might serve as a point of comparison for others. Open one of the carotids of a dog; tie the extremity towards the brain, and fasten a tube to that which is next the heart; then open the carotid of another dog, tie the extremity of the vessel next the heart, and fix the other end of the tube into that which is next the brain; then let the assistant, who meanwhile should have had his fingers upon the artery of the first dog underneath the tube, remove his compression, and the carotid of the second dog will be seen beating under the impulse of the blood injected from the heart of the first. This operation fatigues but little the animal which receives the blood, particularly if one of the veins be previously opened, to prevent too great a fulness of the vessels. It will live very well afterwards. This experiment has been often repeated, and always with the same results.
After this experiment, I opened the carotid, and the jugular vein of another dog, and after tying the extremity of the carotid next the heart, received the blood of the jugular into a warm syringe, and injected it into the brain. The creature appeared immediately to be agitated, breathed quickly, and seemed to be in a state of suffocation, similar to that of asphyxia. Its animal life became entirely extinct; the heart, however, continued to beat, and the circulation to go on for half an hour afterwards; at the end of which time the organic life was terminated also.
This dog was of a middle size, and about six ounces of blood were injected with a gentle impulse, for fear of that being attributed to the shock, which ought to have been the result of the nature and composition of the fluid. I repeated this experiment upon three dogs the same day, and afterwards at different times upon others; the result was invariable, not only as to the asphyxia of the animal, but even as to the concomitant appearances.
It might be thought that out of its vessels, and exposed to the contact of the air, the blood might imbibe a pernicious principle, or be deprived of that which is requisite for the maintenance of life. It might be imagined, that to this cause was owing the sudden death of the dog, on the injection of the brain with venous blood. To shew that this was not the case, I made a small opening in the jugular of a dog, to which I adapted a moderately warm syringe, and pumped the blood immediately from the vein.—It was afterwards thrown into the carotid: the symptoms were the same as the preceding, but less marked, and the death of the creature induced more slowly.—It is probable, then, that the air when in contact with the living blood without its vessels may alter it a little, but the essential cause of death is still the same.
Hence it appears that the black blood either is not an excitant capable of keeping up the cerebral action, or that it acts in a deleterious manner, upon the brain. The injection by the carotid of various other substances will produce analogous effects.
I have killed animals in this way with ink, oil, wine, and water coloured with indigo. The greater number of the excrementitious fluids, such as urine, bile, the mucus of catarrhs, occasion death also by their simple presence on the brain. The serosity of the blood is fatal, but not as quickly so. Now it is certainly upon the substance of the brain, and not upon the internal surface of the arteries, that these different substances exert their influence. I have injected them all into the crural artery. In this way they are none of them mortal, but occasion always a torpor, amounting even to paralysis at times.[92]
The black blood is doubtless fatal to the brain, the brain becoming at once a tonic from its presence. In what way does it act? I do not pretend to determine the manner; for this were only to begin a series of conjectures.
By this time we are authorised to conclude, that in asphyxiæ, the circulation which continues for some time after the interruption of the chemical functions of the lungs, interrupts the cerebral functions, from its being composed of black blood only. The fact is proved in another manner, for the movements of the brain continue to be made as usual.
If the cerebral mass be exposed, and the creature asphyxiated, the animal life will be extinguished, but the motion of the brain will be apparent still. Since then the latter cause of life subsists, the cause of death must be in the nature of the fluid, by which the organ is penetrated.
Nevertheless, if any affection of the brain coincide with asphyxia, the death which is occasioned by the latter, will be quicker than is usually the case. Strike a dog a violent blow upon the head, and then if he be deprived of air, he will die on the instant. In asphyxiating another animal already in a state of stupor, from compression of the brain, I observed that the vital functions were interrupted somewhat sooner, than when the brain is untouched during that operation; but the consequences hitherto deduced, may be supported by other experiments.
If in asphyxia the black blood suspend the action of the cerebral mass, it is evident that the black blood taken from the arteries of an animal dying of asphyxia, and injected into the brain of another, will be the cause of death.
The experiment will be found to succeed—cut the trachea, of a dog, and tie it up hermetically; then in the course of two or three minutes, open the carotid and receive into a syringe the blood, which flows from the vessels; inject it into the brain of another animal, and it will die.
The following experiment is very similar, but offers a somewhat different result. 1st. Adapt a tube with a stop-cock to the trachea of a dog, and a tube of silver to the carotid, next the head, after dividing this vessel, and tie up the extremity towards the heart. 2dly. Fix the other end of the tube to the divided carotid of another dog next the heart, and tie the extremity of the vessel towards the head. 3dly. Shut the cock of the tube in the trachea, and the black blood of the one dog in a short time, will be injected into the brain of the other.
The appearances above described will shortly afterwards succeed, but not so soon as in the former experiment, and if the transfusion be stopped, the animal which has been asphyxiated in this way, may recover and live. In the preceding experiment he will always die. It appears then that some extraneous pernicious principle is imbibed by the venous blood, when in contact with the air. Observe that for the latter experiment the dog from which the brain of the other is to be injected, must be stronger and more vigorous than the other. The reasons are evident.
I was desirous of trying whether the venous blood would not be capable of keeping up the cerebral action, if reddened artificially. For this purpose I opened the jugular and the carotid of a dog, and received the blood of the vein in a vessel filled with oxygen; it immediately became of a vivid purple, but on its injection into the brain, the animal was very suddenly killed. I was much surprised at this result, but ceased to be so on remarking, that a great quantity of air was mixed with the fluid, and that it arrived upon the brain, in a state of foam: now we know that a very small number of bubbles are sufficient to kill an animal, whether they be introduced on the side of the brain, or on that of the heart.
From this reflection, I was induced to repeat my experiments upon the injection of black blood, suspecting as I did that some small quantity of air might in these cases have been contained in the extremity of my syringe. I soon however recollected that if this cause were real, it should produce the same effect in every instance whatever were the fluid employed, now when water is injected there is nothing of the kind observable.
We may be thus assured that the black blood is either incapable of keeping up the action of the brain, or that it acts in a deleterious manner upon that organ, from the very nature of the principles, which it contains. From such datum it should appear that the life of the asphyxiated person might be restored, by pushing on into the brain a sufficient quantity of arterial blood, but here we must make a distinction of two periods in asphyxia: 1st. That in which the cerebral functions are only suspended: 2dly. That in which the circulation and the movements of the breast are stopped (for this disease is ever characterised by the sudden loss of all animal life, and consecutively by that of the organic life.) Now, as long as the first period of asphyxia continues, I have observed that, by the transfusion of red blood into the brain, from the heart of another animal, the movement of the creature which is dying will be restored by degrees, and the cerebral functions resume in part their activity; but this is only a temporary thing, and the animal will fall again into its previous dying state, if the asphyxiating cause be continued.
On the other hand, if during the first period, to which we have alluded, the air be readmitted, into the trachea, the lungs will be reanimated, the blood be coloured, and the creature be revived without the assistance of any transfusion; and such transfusion again is of no avail, after the second period of asphyxia, so that this experiment offers only a proof of what we already know; with respect to the difference of the influence of arterial and venous blood upon the brain, and not a remedy in case of asphyxia.
Again, whenever I have injected venous blood into the brain, by the help of a syringe, I have universally found that such proceeding is fatal. Though the cause of asphyxia be removed, and arterial blood injected, either with the syringe, or immediately from the heart of another animal, it is of little effect, and frequently of none whatever. And in general asphyxia when produced by blood, which has been taken from the venous system itself and pushed into the brain is much more certain and more decided, than that which is occasioned by ligature of the trachea, or the introduction of different gases into the lungs.
After having established by different experiments, how fatal the influence of the black blood is upon the brain, which receives it from the arteries whenever the chemical functions of the lungs are suspended, it will not be amiss or out of place to shew, that the phenomena of the asphyxia, which are observed in the human subject, accord with the experiments of which I have given the detail.
1st. It is generally known that every kind of asphyxia affects the brain in the first instance; that the functions of this organ are the first to be annihilated; that the animal life, and particularly the sensations cease; that all our relations with exterior objects are instantly suspended, and that the organic functions are only consecutively interrupted. Whatever be the mode of asphyxia, by submersion, strangulation, gases, or a vacuum, the same phenomena occur at all times.
2dly. It is known that the greater number of those who have escaped suffocation, have been sensible only of a general stupor, the seat of which has been evidently in the brain. It is known also, that death is almost always certain in these cases, while the pulse and the heart have ceased to be felt.
3dly. It is affirmed by almost all such persons as have survived this accident, especially when caused by the vapour of charcoal, that the first thing of which they were sensible, was more or less pain, in the head, an effect in all probability occasioned by the first influx of the black blood into the brain. This fact has been noted by the greater number of authors, who have written on asphyxia.
4thly. The vulgar expression that “charcoal flies to the head” is surely a proof that the brain, and not the heart, is the first affected in the asphyxia occasioned by this deleterious substance. The unprejudiced vulgar, oftentimes observe more correctly than we do, who frequently see only what we wish to see.[93]
5thly. There are many examples of persons, who after escaping the pernicious effects of the vapour of charcoal, have been subject afterwards to paralytic affections, and loss of memory. Such changes have evidently their seat in the brain. Convulsion also is frequently the effect of the impression of mephitic vapour: head-ache is a common symptom, and for the most part remains after the others have disappeared. In every book of cases may be seen examples of these affections.
In cold-blooded animals, and in reptiles especially, this influence of the black blood on the brain, though real, is much less apparent. Make an incision into both sides of the breast of a frog, then tie the lungs at their root, and the animal will live notwithstanding for a considerable time. Cut away the lungs entirely, and the same phenomenon will be remarked. In fish, the relation between the lungs and the brain, is somewhat more direct, for by the organization of the branchiæ, they differ essentially from reptiles. I have taken away the cartilaginous plate which covers the gills of the carp, the motion of the gills however continued to be made as before, and the animal lived without any apparent injury done to its functions. I afterwards put a ligature about the cartilaginous rings which sustain the branchiæ, so as to hinder all motion in the pulmonary apparatus. The effect was, that the animal languished, his fins dropt, his muscular movements soon grew weak, then ceased entirely, and the creature in the course of a quarter of an hour was dead. The same phenomena with some little variety, were observable in a carp from which I cut away the branchiæ.
After all however, the particular nature of those relations, which unite the heart, the lungs, and the brain, both in the red and cold-blooded animals, is well worthy the farther investigation of physiologists. The latter sort of animals, can neither be subject to syncope or apoplexy, or at least the character of these diseases must be very much modified in them. They are with much more difficulty asphyxiated. We shall now return to those species which bear a nearer resemblance to man.
From the influence of the black blood over the heart, the brain, and the rest of the organs, it was my opinion, that persons affected with varicose aneurisms, would perish less quickly from asphyxia then others; because the red blood passes into the veins, and traverses the lungs without requiring alteration. Accordingly, it should be capable of keeping up the cerebral action.
To be assured if this suspicion were well founded, I made a communication between the carotid artery and jugular vein of a dog, by means of a curved tube. The pulsation of the artery was thus communicated to the vein. I afterwards asphyxiated the animal by stopping the trachea, but the phenomena of death were little different from those of common asphyxia.
We may conclude with certainty, from the various considerations and experiments presented in the present chapter.
1st. That when the chemical phenomena of the lungs are interrupted, the black blood acts upon the brain, as it does upon the heart, by penetrating the tissue of that organ, and depriving it of the excitement, which is necessary to its action.
2dly. That its influence is much more rapid upon the first, than on the second of these organs.
3dly. That it is the inequality of such influence, which occasions the difference in the cessation of the two lives in the case of asphyxia. The animal life is always annihilated before the organic life.
We may conceive from what has been said in this and the preceding chapter, how unfounded are the suspicions of those who have supposed that the brain, after the separation of the head from the body by the guillotine, might live awhile and have sensation. The action of this organ is immediately connected with its double excitements.—1st, By motion; 2dly, By the nature of the blood which it receives. Now, when the interruption of such excitement is sudden, the interruption of every kind of feeling must also be sudden.
When the chemical functions of the lungs are suspended, the disturbance induced in the functions of the brain, has indeed a very considerable influence on the death of the other organs; nevertheless, such disturbance is the beginning of death only in the animal life, and even then is connected with other causes. The organic life ceases from the sole presence of the black blood among the different organs. The death of the brain is only an isolated and partial phenomenon of asphyxia, which does not take place in any particular organ, but in all alike. We shall explain this assertion in the following chapter.