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During these attacks the large arteries femoral, brachial, and subclavian can be felt as firm cords, while pulsation is lost in the peripheral vessels. Gangrene eventually ensues, is attended with great pain and runs a slow course. It is treated on the same lines as Raynaud's disease.
The disturbed circulation is evidenced by imperfect peripheral circulation and capillary sluggishly, with at times pendent edema of the feet and ankles, but, perhaps, little congestion of the lungs. The left ventricle being sufficient, there is no damming back through the left auricle to the lungs.
Petersburg a manometer was introduced into the central end of the carotid artery of a bitch; a male dog was then introduced, and during coitus observations were made on the blood-pressure at the peripheral and central ends of the artery.
As the etiology in many instances of varicose veins is uncertain, he thinks that they may be caused by incompetence of the right heart, more or less temporary perhaps, from muscular exertion. This incompetence being frequently repeated, peripheral veins may dilate.
If it be said, as it may truly be said, that this is too trifling a cause of derangement to produce much effect, then there comes the more important cause with which it co-operates. The medium from which the flocculi have been precipitated, and through which they are moving, must, by gravitation, be rendered denser in its central parts than in its peripheral parts.
In a patient in whom we are trying to cause nervous and muscular rest, strychnin is certainly contraindicated. On the other hand, if the heart is acting sluggishly, the peripheral circulation is imperfect, and atropin is not acting well, it is advisable to give strychnin in a dose not too large and not too frequently repeated.
The explanation of the various phases of this development is reducible to a well-known psychologic law the natural antagonism between sensation and image, between phenomena of peripheral origin and phenomena of central origin; or, in a more general form, between the outer and inner life. I shall not dwell long on this point, which Taine has so admirably treated.
The future of such treatment means an alcoholic sleep with depression, alcoholic excitement which is not desired, or profound nausea and vomiting, with peripheral relaxation and cold perspiration.
Hot climates, a close atmosphere, heavy bed-clothing, hot baths, all tend powerfully to excite the sexual system, for that system is a peripheral sensory organ, and whatever stimulates the skin generally, stimulates the sexual system. Cold, which contracts the skin, also deadens the sexual feelings, a fact which the ascetics of old knew and acted upon.
These local variations are common all over the world, though they are but little observed. In general, the central parts of continents are likely to receive much less rainfall than their peripheral portions. Thus the central districts of North America, Asia, and Australia three out of the five continental masses have what we may call interior deserts.
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