ENDOCRINES, VITAMINS, AND SUBTLETIES: Abstract of an Address delivered to the Sunderland Division of the British Medical Association
Authors: L. Williams
Journal: BMJ (1923)

fMDCLJUK.Onie could continiue to multiply examples of conditions in which this dangerous complex may arise.Apart from agents directlv toxic in themselves, the position is com- plicated by the fact that, when blood is subjected to injurious influenices, as by contact with otherwise inert sub- stances acting as " foreign " surfaces, so that processes are initiated in it which, outside the body, would lead to clotting, it acquires a toxicity of this type.(Cf.Novy and De Kruif,29 Dale and Kellaway.23)WVhen vou also remember that, apart from dilatation anid increase of permeability of the capillaries due to loss of their contractile tone, effects at least superficially similar cani probably be produced by substances which directly poison the endothelial wall and disorganiize its delicate structure, it will be obvious that there may be difficulty in deciding as to the precise nature of a particular effect.Salvarsan, for example, as an arsenical derivative, may, and in sonie cases probably does, act as a direct endothelial poison.It is also a colloidal substance which, on injectioni, may be so precipitated in the blood as to iniitiate precoagulationi chaniges.Both types of effect probably figure amonig the toxic effects which salvarsani occasionally produces.Unfortunately methods of dealing effectively with dilated and permeable capillaries are not easy to finid.The actioni of adrenaline, above mentioned, suggests itself; anid there are cases in which it seems to have value.As a prophlylactic or a remedy for the immediate, so-called vasomotor, reaction sometimes produced by salvarsan, for example, there seems to be no room for doubt that adrenaline is effective; and its effectiveness supports the suggestion, made on other grounds, that this type of reaction is due to capillary dilata- tioIn caused by precoagulation chaniges in the blood, anid not to poisoning of the endothelium.Calcium has had a repu- tation for reducinig the tendency to excessive permeability of the capillary walls.Krogh's recent evidenice as to the tonic action of pituitary extract should find some ther a- peutic application.Experience during the war, however, presented as practically inisoluble the problem of restoring the volume of blood in effective currency when once the capillaries had become thoroughly lax and permeable.Saline solutions, guim saline, or even blood itself, often produced but a temporary recovery of volume, the fluid escaping from the vessels, oIr becoming removed from circulation, almost as fast as it was infused into the veins.In some of Dr.Hardiiig's experiments, in the investigationi alr-eady mileni- tionied, tlhee coiikl be seen what appeared to be a seconidary, anld rapidly fatal, accentuation of the toxic collapse, when blood which lhad lain stagnant in toxaemically dilated capil- laries was waslhed back into circuilationi by aii infusion.The therapeutic problem is a peculiarly difficult anid com- plex one; but the first step towards its rationial solution is a clear recognition of the niature of the condition calling, for treatment.