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intelligible and scientific than tlie famous aphorism that
"jN^atiire abhors a vacuum," They express, however, as clear-
ly as it is possible to express any thing so intangible, the ideas
intended to be conveyed by the term " substitution^^ the sub-
stitution of one morbid Buy Erectalis Online process for another by a sort of hood-
winking of the system. But " substitution " has to share the
honors with ^^ revulsion'''' or " derivation^'' terms employed to
express the accumulation of an excess Erectalis Tablets of blood in the place
irritated, which excess is supposed to be drawn, wholly or in
part, from Erectalis Online the diseased locality. This idea has at least the
merit of being intelligible, and expresses, I think, a partial
truth. But it is met by the objection that the extra quantity
of blood under a sinapism, for example, is so insignificant that
its abstraction could have no appreciable efiect upon a distant
organ, with which there may be no direct vascular connection.
This objection is valid from the stand-point from which it is
taken.
Rejecting the idea that either the nerves or the blood-ves-
sels play any considerable part in the action of counter-irri-
tants, Mr. E.OSS ' has put forward the theory that the effect is
produced by a modification of nutrition, communicated from
cell to cell of the intervening parenchyma, without regard to
whether the tissues be continuous, or, as in the case of internal
organs, merely contiguous. The absurdity of his theory is
shown by one of his illustrations, that of flatulent colic, re-
lieved by a sinapism to the abdomen. He aftirms that the
irritation causes a change of nutrition which is propagated
from cell to cell through the integument, fasciae, and muscles,
until it reaches the inner surface of the parietal peritonaeum,
whence it is transferred to the visceral serous surface, and pen-
etrates to the muscular coat. Here it produces an im.])roved
nut/rition, which gives the muscular fibre sufiicient power to
expel the flatus. (!)
Except in cases resembling the above, in which the pain
results from a mechanical cause capable of being removed by
muscular action excited by reflex irritation, I hold that all
the benefits resulting from counter-irritation are obtained di-
' " On Counter-Irritation : A Theory constructed by tlie Deductive
Method of Investigation," By James Koss, M. D. London, 1869.
CIRCULATION^ OF THE BLOOD. 341
rectly or indirectly throiigli the circulation. In the first place,
I consider all pain (excluding that from extraneous irritation)
as proceeding from imperfect nutrition, even though there be
no evidence of inflammation. This is only in accordance with
the proposition that there can be no derangement of function
without change of structure. ISTow, if the morbid condition be
one dependent upon the quantity (not quality) of the blood
supplied to the part which is the seat of pain, then, in my
view, counter-irritation may be of service, but not otherwise.
In the case of inflammatory action, the agency of the vessels
will be admitted with less argument. But the difficulty in
either case has been that already stated — that the ajpparent
chano;e in the circulation is too trivial to be credited with the
results observed. I reserve the word " apparent," and on this
reservation my entire argument will rest. With the excep-
tion mentioned in the foot-note,^ in all the discussions upon
this subject, up to the present time, so far as my knowledge ex-
tends, attention has been confined to the excess of blood con-
tained in the irritated part. If, for example, the entire mass of
tissue to which the irritation extends could be cut out at one
stroke, and the blood expressed from it, the excess Buy Erectalis of this blood
over what would naturally be contained in the same quantity
of tissue, would represent what has been considered as the sum
total of the change supposed to have been effected in the circu-
lation at that point. Or, if the irritation was supposed to be
reflected upon some other point, the result there was regarded
in the same light.
It is here that I think a mistake has been made. The
question is not, how much hlood the vessels of the irritated
fart ivill hold, hut how much they ivill transmit in a given
time. This becomes evident when we consider that a given
amount of blood passes through the capillaries of the body in
each unit of time, and is transferred from the arterial to the
' The germ, from wliicli the views here given are developed, is de-
rived from a lecture by Prof. Virchow, which I heard in 1860, but which
I have never seen in print. His reference to the subject was limited to the
suggestion that increasing the capillary circulation in the part supplied by
an arterial twig implied a diminution of the circulation in the capillaries
derived from collaterul branches.
342 CIECPLATION OF THE BLOOD.
venous side of the circulation, and that the quantity passing
through any one part must afiect that passing through the re-
mainder of the body, since the latter must be tlie exact com-
plement of the former. Thus, if in a given time four pounds
of blood pass through the capillaries of the entire body, and
one pound passes through the capillaries of the arms, it follows
that three pounds must pass through the remainder of the cap-
illary system. ISTow, if we plunge the arms into hot water,
and dilate the vessels so that an additional half pound passes
through them, the remaining vessels will transmft but two and
a half pounds, and the tissues which they supply will be de-
prived for the time of one-sixth of their nourishment. It will
be perceived that this is a matter entirely apart from the
quantity of blood wliich might be contained in the arms if
severed from the body.
The consideration of the increase of the carrying power of
tubes, in comparison with the increase in their diameter, in-
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