Wrisberg Node

Wrisberg Node, refers to the plexus cardiacus superficialis, located on the surface of the heart, between the aorta and pulmonary artery, and formed by the n. vagus and n. sympathicus. From this node, fibers penetrate the thickness of the cardiac muscle, as well as go to the a. coronaria sinistra. The histological structure is similar to that of the nodes of the sympathetic trunk and allows it to be classified as the sympathetic part of the plexus. In BORN BEFORE BIRTH, obtained before birth. Under congenital diseases should be understood those whose onset refers to the intrauterine existence of the individual or even to the moment of conception. In some places, a more restrictive definition of this concept can be encountered, where under V. are understood such diseases with which the individual is born into the world. With such a definition, however, one cannot agree for the reason that both intrauterine and hereditary influences do not necessarily manifest themselves from the very first moments of extrauterine life, but often, on the contrary, make themselves known much later - in later periods of the individual's existence. Congenital diseases should not be confused with hereditary diseases. The latter are those diseases that relatives of the individual suffered in ascending generations, while congenital diseases are often acquired during the period of intrauterine existence. It follows that every hereditary disease is at the same time congenital, whereas not every congenital disease is simultaneously hereditary. The question of the genesis of congenital diseases is closely related to the question of the so-called blastophoria, or damage to the germ («Keimschadigung» of German authors), since all moments leading to such diseases essentially reduce to two kinds of influences - either on the fetus or on the parental generative elements. The former include such moments as anomalies or lesions of fetal membranes (e.g., amnion), which in some cases can lead to deformities; further, infections and intoxications of the fetus by the placental route, and also, apparently, insufficiency of some endocrine glands of the mother, judging by cases of mongolism in the child with insufficiency of the maternal thyroid gland (in Stoeltzner's observations); the latter include various harmful influences, mostly of a toxic nature, acting on the germ cells of parents - either chronically (alcoholism, morphinism, poisoning with lead, mercury, and even iodine, according to Adler's data; infectious diseases of parents may also have the same significance: syphilis, tuberculosis, malaria, etc.) or damaging them through a single exposure (unfavorable influence on offspring from conception in a state of intoxication of parents, according to a number of observations). The same result can also be given, among other things, by the radiography of the genital sphere, performed for therapeutic purposes or for the prevention of conception (radiography of the ovaries), as is evident from the experimental observations of Hertwigs (O. and R. Hertwig) on the radiography of frog spermatozoa, when the possibility was proven to a certain extent and with a certain strength of exposure to obtain a dissociated effect from the rays, in the sense of damaging the chromatin of the spermatozoon, while preserving, however, its motility and, apparently, its fertilizing ability. Whether chemical contraceptive substances can act in a similar manner in cases where they do not kill or immobilize spermatozoa - is an open question, but deserving of attention, judging by the data of R. Hertwig, who obtained defective offspring in frogs as a result of fertilizing normal eggs with sperm previously treated with methylene blue and trypaflavin. Specifically regarding the question of the influence of alcohol on offspring, however, the opinions of authors are not unanimous: Bumke (Witke), for example, doubts the possibility of such a fatal influence of parental intoxication at the moment of conception, while Schallmeyer, Toenniessen and others think that alcohol, like many other harmful substances, usually acts only on the cytoplasm, and not on the substrate of the hereditary dispositions of the germ cells. However, neither of these opinions can be considered sufficiently substantiated, and in any case other competent authors (Orth and others) hold completely different views on this matter. In particular, regarding the significance of chronic alcoholism in this sense, the question could be considered resolved by the experimental observations of Stockard, who established in guinea pigs the fact of the profound influence of alcohol on offspring, in the sense of «idiokinesis», i.e., change in the hereditary substrate, with the subsequent transmission of acquired deviations by inheritance. The participation of parental generative elements in the origin of congenital infections is comparatively small, since the contagium is most often transmitted by the placental route, but the possibility of this kind is also limited by a number of factors, so that ultimately such cases of this kind occur much less frequently than one might expect. In this respect, the question of congenital tbc and congenital syphilis has received the greatest significance in pathology. Baumgarten considers the majority of tuberculosis cases to be congenital tbc, and the latter, in his opinion, usually remains for a longer or shorter time in a latent state, allegedly encountering resistance from first embryonic, and then generally growing cells and tissues. However, another opinion prevails, according to which extrauterine tbc sharply predominates in frequency over intrauterine tbc, and in particular, Baumgarten's doctrine of the decisive significance of the resistance of embryonic tissues to the contagium has also met with objections. Be that as it may, at the present time, an extremely small number of cases of undoubtedly congenital tuberculosis is registered in the literature, although, on the other hand, one can hardly doubt that some of the cases included here are overlooked due to the lack of detailed research. On the contrary, congenital syphilis, compared to congenital tuberculosis, apparently deserves greater attention. But, along with the possibility of congenital (in the exact sense of the word) tbc and, especially, syphilis, it is necessary to reckon with the possibility of blastophoria in the above-mentioned sense in both infections. In relation to syphilis, the overwhelming majority of authors do not doubt this possibility, and, among other things, the pathogenesis of some mental diseases is interpreted precisely in this sense. While (according to Vidakovich's data) in the semen of a normal man there are, on average, 10 abnormal spermatozoa per 1,000 normal ones due to deviations in karyokinesis, in the semen of syphilitics there are 5 times more such abnormal spermatozoa, and moreover, some pathological forms of spermatozoa are allegedly characteristic exclusively of lues. For assessing the significance, from a pathological point of view, of tuberculous blastophoria, there are not yet sufficient data, and one could only say that at least the hereditarily transmitted habitus phthisicus is not in direct connection with the tuberculosis of the parents. Anomalies of spermatogenesis with corresponding consequences for offspring (weak offspring) are quite possible depending on the advanced age of the parent, and the harmful influence of such factors as inbreeding or, conversely, unsuccessful mixing of races is determined mainly by the quality of the idioplasm.

G. Sakharov. Congenital weakness (debilitas congenita), a condition in which a newborn child, due to incomplete or weak development of the organism, shows reduced viability, and in case of survival, retardation in development. Congenital weakness is caused by: 1) premature birth, 2) poor conditions for intrauterine growth, and 3) inadequacy of hereditary material. In practical terms, the exact differential diagnosis between congenital weakness due to prematurity and due to other causes is not important, since both the symptoms and the rearing conditions are the same for all categories of congenitally weak. Common signs for all congenitally weak should be considered delicacy of structure, thinness and easy vulnerability of the skin, weak development, and sometimes absence of subcutaneous tissue, flaccidity of muscles, weak manifestation of the sucking, and sometimes swallowing reflexes, weak cry, drowsiness, reduced temperature, lower resistance to all external irritations, and higher mortality. According to various statistical data, the congenitally weak constitute 5-20% of all live births. The largest number of congenitally weak are premature infants. Prematurity is established by measurement data, the external appearance, and functional manifestations of the child. In practice, it is advisable to consider a child born with a weight of less than 2,500g as premature. By the time of birth, premature infants should be divided into immature (im-maturi) and unripe (praematuri). The lower limit of unripeness, according to most authors, is 24 weeks. The smallest premature infant who lived the longest was described by Barker (400 grams, 23 weeks, lived 4¹/₂ years). According to German and French laws, the term for a viable fetus is set at 180 days of pregnancy (6 months). By weight, premature infants can be divided into three groups: 1) the weakest, from 1,000 to 1,500 g (7th month), 2) medium, from 1,500 to 2,000 g (8th month), and 3) strong, from 2,000 to 2,500 g (9th month). With proper rearing, the weak group gives up to 20% survival rate, the medium up to 70%, and the strong up to 90%. In rearing congenitally weak children, it is necessary to take into account poor thermoregulatory adaptability and the difficulty of feeding them. The weak thermoregulatory capacity, caused by the absence of subcutaneous fat, the larger surface area of the body in relation to weight, weak oxidative processes, and underdevelopment of thermoregulatory centers, requires careful protection from heat loss. For the strong group, this is achieved by warmer clothing and wrapping with hot water bottles. For the medium and weak groups, it is necessary to prevent heat loss not only through the skin but also through respiration, for which purpose special apparatus-incubators, or coves with constantly maintained temperature from 25° to 32.5°, depending on the degree of weakness, and consequently, coolability of the child, are arranged. The most perfect coves are the Tarnier-Lyon and Finkelstein systems. Feeding congenitally weak children presents great difficulties. If the child fully masters the act of sucking, the success of feeding is ensured. But the more pronounced the congenital weakness, the weaker the sucking reflex is expressed, and in the weakest, the swallowing reflex is also absent. With weak manifestation of sucking movements, one has to feed with expressed milk through a cap attachment to develop the sucking apparatus. In complete absence of sucking, feeding must be done with a spoon (Kermauner's beak-shaped spoon). In case of absence of the swallowing reflex, it is necessary to use the drop method through the nose (to prevent milk drops from entering the respiratory tract). If this method fails, feeding through a tube (Nelaton's catheter No. 14) remains. That mother's milk is the best food for the congenitally weak is not disputed. In its absence, the most suitable is wet nurse's milk, and only in extreme cases is artificial feeding allowed (ordinary milk mixtures, Bidertz mixtures, Cherny-Kleinshmidt mixtures, buttermilk). For dosage, one can use the formula: for a single dose-7_th part of the weight plus the number of days lived; in the first days, the child usually does not accept such a dose, which is why it has to be reduced by 2-3 times, gradually increasing it by the 7th day to the formula. The frequency of feeding is established for the weakest-every 1-1¹/₂ hours, medium-1¹/₂-2 hours, and strong-2-2¹/₂ hours. The caloric requirement of the congenitally weak is calculated at 120-150 calories per 1 kg of weight or ¹/₂ of the weight. In other respects, congenitally weak children require the following special care. Possibly strict aseptic conditions and isolation of the sick, as susceptibility to infections characteristic of early childhood (septic diseases, influenza) is extremely high in such children. Children should not be bathed at first to avoid cooling. It is necessary to maintain heart activity with stimulants. In cases of secondary asphyxia caused by collapse of the lungs (atelectasis), it is necessary to apply reflex irritations, oxygen. Congenitally weak children may be subject to all those diseases and specific physiological conditions that are characteristic of the newborn period, and all these processes proceed in a more severe form and give worse prognoses. It would seem that the less developed the fetus, the less it should suffer from birth trauma. In fact, cases of severe consequences of birth trauma (mainly cranial hemorrhages) are very common in them, which is obviously caused by the delicacy of all tissues and the easy vulnerability of blood vessels. - The prognosis for congenitally weak children depends on the cause of the congenital weakness and the rearing conditions. If the congenital weakness is caused by unfavorable conditions for intrauterine growth or hereditary-constitutional causes, the prognosis worsens, because in such a child's organism there is not only insufficient functional adaptation to extrauterine existence, but also inadequacy of all cells, tissues, and organs caused by toxic or constitutional factors. The first year of life is especially dangerous for congenitally weak children. In case of survival, their further development depends on the degree of congenital weakness. The more pronounced the congenital weakness (smaller size), the more retarded the development is from the norm. This is probably dependent on the underdevelopment of the endocrine apparatus, which plays a role in the growth process (thymus, anterior lobe of the pituitary gland, gonads).

A. Vladikin. ABSORPTION, the penetration of substances from the surface of mucous membranes, lungs, or skin (resp. from a wound surface) into the depths of cells and tissues with the subsequent transition of substances into the lymph or blood stream. Absorption is usually also called the dissolution of substances when they are introduced under the skin, into muscles, lymphatic spaces, and serous cavities. Absorption occurs through the mediation of filtration, osmosis, and diffusion, and finally with the help of other processes, not yet fully clarified, in which the vital activity of living protoplasm is manifested. 1. In filtration, liquids and gases penetrate through the pores of tissues under the influence of hydrostatic pressure (resp. gas pressure). In the intestine, filtration depends mainly on the suction work of the villi, which, through successive contractions and relaxations, act like microscopic pumps (Brücke). This work of the mucous membrane of the small intestine is proven by an experiment in which two communicating vessels, filled with an isotonic solution of NaCl, are separated by a piece of intestinal wall taken from a rabbit killed during the period of food digestion. A current of liquid arises between both vessels through the intestinal wall in the direction from the mucous to the serous membrane (Reid). Substances absorbed by the intestinal villi enter the lymphatic spaces of the latter, from which some pass into the circulatory system, while others continue along the lymphatic pathways (fats). The pressure inside the intestine, due to the tone of the intestinal and abdominal wall muscles, has a barely noticeable effect on filtration due to its insignificance. In addition to the direct effect, pressure can also have an indirect effect on absorption. Thus, an increase in pressure in the intestine, on the one hand, straightens the folds and increases the absorbing surface, and on the other hand, after a certain limit (about 140 cm of water column), it compresses the blood vessels and thereby hinders absorption. 2. The forces causing osmotic and diffusion currents are: on the one hand, the difference in osmotic pressure in the fluids, depending on the difference in the concentration of the total number of molecules and dissociated ions of dissolved substances; this difference causes the solvent to pass from a hypotonic solution to a hypertonic one; on the other hand, the difference in the partial osmotic pressure of certain specific molecules (resp. ions) causes the movement of dissolved substances in the solvent. Since filtration and diffusion-osmotic processes occur simultaneously, they can cause phenomena that could not be explained if only filtration existed (e.g., uneven absorption of solvent and dissolved substance) or only diffusion and osmosis (e.g., absorption of salts from a hypotonic solution), and are easily explainable in the presence of both. The relationship of the membrane to the solvent and the dissolved substance is of greater significance for the processes under consideration. The membrane can be: a) completely impermeable, b) semi-permeable (allowing the solvent to pass but not a given dissolved substance) or c) allowing to some extent both the solvent and the dissolved substance,-a case most often observed in the absorption by mucous membranes. The permeability of tissues (resp. membranes) to various substances depends both on the porosity of the tissues and the size of the molecules of the dissolved substance, with the tissues acting as if they were the finest filters, and also on the physicochemical relationship of the tissues to a given substance (e.g., their ability to adsorb or dissolve a given substance). Cellular lipoids, which form the outer layer in cells, a kind of cell membrane, and cause faster absorption of substances soluble in lipoids compared to insoluble ones (for example, ethyl alcohol compared to NaCl), are particularly important in this regard. According to the Overton-Meyer theory, what is particularly important here is not so much the absolute solubility of a given substance in lipoids as the so-called distribution coefficient, i.e., the ratio of the solubility of a given substance in lipoids to its solubility in water. According to Heubner, the absorption of substances soluble in lipoids is carried out by cells (intracellularly), while substances insoluble in lipoids (including food substances, salts, and sugar) are absorbed intercellularly, penetrating between cells,-an opinion with which other authors (Starling) disagree, considering the latter type of absorption proven only for substances foreign to the organism. The ability of the dissolved substance to change surface tension at the boundary of the solvent and the absorbing surface plays a significant role in absorption. According to the Gibbs-Thomson theory, substances that reduce surface tension accumulate in a higher concentration at the boundary of the solvent phase, resp. at the boundary mentioned above, and are therefore absorbed more quickly (Traube). The absorption of substances insoluble in lipoids proceeds much more slowly than that of soluble ones and depends primarily on the rate of their diffusion. In isotonic or slightly hypertonic solutions, neutral salts, both in terms of the rate of their absorption and the rate of diffusion, can be arranged in the following series: for anions- HPO₄432; an example of this is the work of the intestinal villi mentioned above. When tissues die, the absorption process naturally depends entirely on filtration, osmosis, and diffusion. Since the main obstacle to the absorption of substances insoluble in lipoids is the outer lipoid layer of cells, substances that directly loosen this layer (e.g., alcohol), as well as those acting in a similar way due to the irritation or inflammation they cause in the tissues (pepper, mustard), promote the absorption of substances insoluble in lipoids, and this can occur in places where it would otherwise not take place (e.g., in the stomach). The resulting hyperemia may or may not have an effect on absorption (intestine, stomach). The high temperature of the substance introduced also has a noticeable effect on absorption, causing hyperemia. Substances that destroy the mucous membrane sharply affect absorption; for example, salts of heavy metals are absorbed more quickly by the digestive tract when acting in concentrations that cauterize the mucous membrane. The so-called "coating" substances have the opposite effect, sharply slowing absorption partly because they adsorb the substances being absorbed and then, slowly penetrating through the membranes, also delay the penetration of the substances they have adsorbed, and partly because, by adsorbing to the mucous membrane itself, they can hinder the passage of substances through it. Similarly, a decrease in absorption may depend on the catarrhal condition of the mucous membranes. The main sites for the absorption of substances by the human organism are the digestive tract and respiratory organs. To a much lesser extent, substances are absorbed by the mucous membranes of other organs, and finally by the skin. Absorption in the digestive tract. Substances taken per os in the digestive tract are affected by a number of factors (large amounts of liquid, both introduced with food and secreted by the digestive tract glands, acidic and alkaline environments in different parts of the tract, digestive enzymes, and finally bacteria in the large intestine) and undergo very significant physicochemical changes (dissolution, emulsification, exchange decomposition, reduction, splitting-ether-like compounds-and others). These changes affect the absorbability of the introduced substances, and along with cases where absorption increases, a decrease in it is also observed (e.g., absorption of silver when its nitrate salt passes into insoluble chloride under the influence of HCl of gastric juice). Considering absorption by parts of the digestive tract, it can be seen that water and products of food digestion, as well as other substances insoluble in lipoids, are almost completely not absorbed by the mucous membranes of the mouth and stomach. Some authors, however, admit the absorption of fairly large amounts of salts and peptones in the stomach (meat N, according to Töllner, up to 20-30%). Substances soluble in lipoids (such as alcohol, phenol, nicotine), however, penetrate into the blood both from the mouth and from the stomach and are absorbed quickly. The small intestine is the main absorbing organ for both substances soluble in lipoids and insoluble ones (but the former are absorbed much faster).

Of food substances, proteins are absorbed in the form of products of their digestion, mainly amino acids, but earlier stages of their breakdown and unchanged proteins may also be absorbed, such as blood serum, milk proteins, meat juice mixed with table salt, egg white, and others. The absorption of unchanged proteins may be facilitated by special permeability of the mucous membrane (in newborns) or its disease. The path of absorption of products of protein digestion is the blood vessels, since after ligation of the thoracic duct, proteins introduced with food are absorbed just as well as in the normal state. Of carbohydrates, monosaccharides—glucose, levulose, fructose, galactose, which are the end products of the breakdown of poly- and disaccharides—are easily absorbed. Levulose is absorbed the fastest. Disaccharides, if absorbed, are absorbed more slowly. Dextrin may also be absorbed to some degree. When administered per os, after absorption from the intestine, carbohydrates enter the portal vein blood, and only with very large administration can a small part of them be found in the lymph. Contrary to the previously widespread opinion of Exner about the absorption of fats in the form of an emulsion, according to Pfluger, they are not absorbed as such, but after breakdown into water-soluble glycerin and water-insoluble fatty acids, however, they are converted into a solution by bile and alkaline intestinal juices partly in the form of soaps, partly in the form of free fatty acids. After absorption, fatty acids are released by dissociation from their previous compounds and then immediately combine with glycerin, turning into neutral fat. This process occurs in the epithelial cells of the mucous membrane. The main path of fat from the intestinal mucosa is the lymphatic system, and to a lesser extent, the blood vessels. Absorption in the large intestine is similar to absorption in the small intestine; absorption of water in the large intestine occurs especially actively, while absorption of other substances is slower. Absorption from the lower part of the large intestine is carried out with the help of vv. haemorrhoidales media et inferior, and absorbed substances enter the vena cava inferior, bypassing the portal vein system and liver. Absorption by respiratory organs. Respiratory organs, adapted for the absorption of oxygen, absorb gases and other gases extremely quickly; in this case, both the pressure of the gas and its relationship to the tissues and fluids of the lungs, solubility in them, etc., are important. With increased pressure, air, resp. N, can penetrate through undamaged lungs in a gaseous state into the mediastinum, causing emphysema in it, and into the blood—in the form of bubbles. The condition of the bronchi and lungs, their blood filling, swelling of the membranes, as well as the edema caused by some poisons have a very significant influence on the absorptive capacity of the lungs. In addition to purely physical relationships, according to a number of authors (Bohr, Haldane, etc.), under certain conditions (e.g., increased work, lack of O₂ in the atmosphere), special biological processes also play a role in the absorption of oxygen by the lungs, during which O₂ can be absorbed by the alveolar epithelium and enter the blood even with a lower partial pressure in the lungs than in the blood. Other authors (Sechenov, Pfluger, Krogh) recognize only the diffusion theory of respiration. The absorption of liquids and solutions by respiratory organs differs from absorption by the digestive tract in that diffusion-osmotic processes have greater significance here. However, the phenomena here also appear quite complex: while water is absorbed from the respiratory tract quickly, an isotonic NaCl solution is absorbed somewhat more slowly, and the same glucose solution is not absorbed at all. In general, the absorption of soluble substances by the lungs occurs not only faster than from the digestive tract, but even faster than from subcutaneous tissue. Substances absorbed by the lungs, in relatively high concentration, very quickly enter the left heart and can cause its poisoning (chloroform). Insoluble substances introduced in the form of smoke or dust and penetrating into lymphatic spaces, and from there into lymph glands, are also absorbed by the respiratory tract. Absorption by the mucous membranes of the nose, eyes, and skin of the external auditory canal is important when using drugs for local effect. At the same time, a general effect is also possible. Absorption by the urinary tract. A healthy bladder absorbs almost no substances insoluble in lipoids. The urethra absorbs, as do the ureters. A healthy vagina and uterus absorb almost nothing; in the postpartum period, absorption occurs much more actively. Absorption by the skin. The skin absorbs gases, vapors, and volatile liquids, as well as substances soluble in lipoids and those that dissolve them, and due to the multilayered nature of the epithelium, it absorbs more slowly than the mucous membrane of the digestive tract. Skin deprived of the epidermis absorbs faster. When ointments are rubbed into the skin, substances penetrate into the sebaceous glands and hair follicles, the contents of which, combining with the rubbed substances, can contribute to their absorption (mercury). A constant galvanic current significantly accelerates absorption through the skin, in which case whole molecules (cataphoresis, resp. electroosmosis) and dissociated ions (iontophoresis) can move. Absorption also occurs when substances are introduced into the subcutaneous tissue, into muscles, into the lymphatic spaces of the spinal cord, and into serous cavities (such absorption is more correctly called resorption). The mentioned methods of administration, especially into the subcutaneous tissue, and to some extent into muscles, are widely used when administering drugs. Subcutaneous administration, compared to per os administration, has the following advantages: 1) absorption occurs faster, 2) drugs are less altered, 3) there is the possibility of more precise dosing. Disadvantages: 1) local irritation (with some substances—necrosis), 2) greater toxicity. When administered into muscles, substances are absorbed faster than when administered subcutaneously, and local irritation is significantly weaker. Administration into the spinal canal aims to bring substances into direct contact with the central nervous system and the nerve trunks extending from it.

A. Likhachev.

The law of 'All or Nothing' in a brief formulation comes down to the following: an excitable substance (nerve centers, fibers, cardiac and striated muscles) in response to any single stimulation gives either a maximum reaction or no reaction at all. For the heart, the English physiologist E. Starling gave the following definition: 'If a contraction of the heart takes place at all, it is always maximum, in the sense that the volume of contraction does not depend on the strength of the stimulus, but on other conditions affecting the muscle at the moment of its activity.' The average-sized contraction of striated muscle is explained from the point of view of this law by the participation of only a part of the muscle fibers, each contracting with maximum force. This position was first stated by Wundt in 1876 for nerve centers, then it was extended to nerves and muscles, although its applicability to all excitable substances was disputed by very authoritative scientists (Sherrington, Hill). A series of experiments were conducted to test this law; its applicability to muscles (Lucas, Adrian, Brücke's laboratory, Lazarev) and to nerves (Franklin, Troland, Kato, Lazarev) was studied. However, it should be admitted that in interpreting the obtained results, specialists differ, and in addition, many researchers observed facts that do not fit into the framework of the 'All or Nothing' law. As Uhtomsky rightly points out, this law has a great attractive force for some physiologists, because the explanation of phenomena in an excitable substance, assuming the 'All or Nothing' law, is extremely simplified, and this law 'allows calculations to be made, so to speak, by arithmetic methods where otherwise even a simple description of phenomena requires methods of higher analysis'. The 'All or Nothing' law was the program topic of the II Congress of Physiologists in 1926, and around it a struggle of opinions still continues (see also Excitation).