Chapter 2. Human s physiology.

Chapter 2. Physiology

Does human physiology exist?

Until now, we do not have a real work on human physiology. There is only animal physiology based on countless experiments on laboratory animals. But their composition of extracellular and intracellular fluids is completely different from the humoral composition of the human body. For example, a dog's juices contain much less potassium and much more sodium chloride than humans. The percentage of histamine in dogs is different from that in humans. Rabbits, guinea pigs are herbivores, man is carnivorous and omnivorous. In terms of species, frogs and mice are even more distant from humans. Most of the experiments on laboratory animals were carried out in an atmosphere of compulsion. The animals in the experiments are tied up, wounded, physically and morally poisoned. They are contained in poorly ventilated cells, their functions are abnormal.

We do not deny the great importance of animal physiology, but we think that it is necessary to take into account the living conditions of laboratory animals in order to have the right to draw not too hasty conclusions. For there are cases when painful physiological experiments on animals lead to "tortured" conclusions. Below we will try to present some reflections on truly human physiology.

Based on a comparison of some data from classical physiology, we will allow ourselves to imagine several of the most important functions of the human body.

Capillaries

There is an endothelial barrier between blood and extracellular fluid - these are capillaries. Their diameters are different. There are very wide capillaries (20-30 microns) and narrower ones (5-6 microns). Capillaries are formed by endothelial cells, some of them are poorly differentiated, more capable of phagocytosis. These young cells are able to retain and digest aging red blood cells, pigments (in malaria), and cholesterol components.

The blood capillaries are constantly changing. In certain places, they can reproduce or undergo reverse development. When they are filled with blood, the endothelial cells retain their flattened shape. With a delay in blood flow in the capillary, endothelial cells again form outgrowths (kidneys). At the same time, their original numerous potencies are revived, and various variants of mesenchymal tissue develop from these cells in connection with the termination of their normal functions. The diameter of the capillaries changes by 2 and 3 times. At maximum tone, the capillaries are so narrowed that they do not let the blood cells pass; only plasma can leak. And vice versa, with a sharp relaxation of the tone of the walls of the capillary, a lot of blood accumulates in their expanded lumen. In the case of shock, this phenomenon is of great importance, since there is a real bloodletting into the vasculature of the abdominal cavity as a result of stagnation in the super-expanded network of capillaries.

The motor function of the capillaries plays a role in every painful process: in inflammation, in traumatic, toxic, infectious shock and in trophic disorders. Changes in the lumen of the capillaries also play a very important role in regulating blood pressure: when all capillaries are dilated, there is a strong drop in blood pressure.

Capillary permeability. The endothelium is a living filtering membrane, by no means inert, with variable permeability, which controls the exchange between blood and extracellular fluids. In the normal state, the membrane allows small molecules (water, crystalloids, amino acids, urea) to pass through, but retains protein molecules. In pathological conditions, the permeability of the capillary membrane increases, and then protein molecules of blood plasma can leak through the endothelium. The degree of permeability of the capillary wall plays an important role in normal and pathological physiology (with the phenomena of secretion and resorption and in the pathogenesis of edema and inflammation).

The passage of fluids through the walls of the capillaries is controlled by the following factors.

1) The total length of the filtering surface. It is sometimes huge. Krogh believes that the total surface of the capillaries of an adult is 6300 m, i.e. a tape 1 m wide and more than 6 km long. This is an important factor for metabolic processes, it changes due to a change in the diameter of the capillaries (gout, diabetes, chronic rheumatism, arteritis).

2) The permeability of the walls themselves. The endothelial membrane is much more permeable than other membranes in the body. In frogs, endothelial membranes are 300 times more permeable than the walls of other cells, and 100 times more than the walls of red blood cells.

3) Pressure on both sides of the diaphragm. From the outside and from the inside, the pressure is carried out in two opposite directions, the blood pressure assists in filtering outward. Under normal conditions, it reaches 40 mm of water in humans. Art. in arterial loops, 22 cm - in venous. As shown by Starling, the filtration pressure is opposed by the oncotic pressure of the plasma colloids, which tends to retain water in the vessels. This pressure in humans corresponds to 36 mm of water. Art. Subject to numerous influences, blood pressure is highly variable, which causes an alternation of filtration and absorption of water, as well as all metabolic processes that characterize the life of tissues.

Countless normal and pathological processes are due to these factors. In this part of the circulatory system, continuous oscillations are observed, establishing an average equilibrium, one of those equilibria that Claude Bernard (Bernard) said that "they result from a constant and precise alignment, as it were on the most sensitive scales."

Between filtration and suction at the capillary level, there is an endless movement of fluids back and forth in a confined space; liquids are constantly striving for equilibrium.

The capillaries have some resistance, adapted to the blood pressure in the area. The fragility of the capillaries increases with avitaminosis C (scurvy) and under the influence of histamine, therefore, extreme caution is needed in the treatment of peptic ulcer disease. Banks (bloodsucking) increase capillary resistance. The strength of the capillaries seems to depend especially on the surrounding fibers.

Classical hemodynamics views the heart as a central motor that drives blood into the arteries, transporting nutrients to areas where there is a continuous exchange between blood and tissues, where, according to the classical concept, the capillaries remain inert, passive, like the entire venous circulatory system.

Chauvois (1957), a former employee of d'Arsonval (d'Arsonval), in his brochure "Place the veins" argues that the initial and dominant role belongs to the venous sector of blood circulation. “The heart does nothing else,” he said, “as soon as it pushes the blood forward, and it is not it that returns such primary elements to the blood as proteins, carbohydrates, lipids, etc.”.

In fact, after the important works of August Krogh, it must be admitted that the initial and dominant role belongs to the capillaries, which represent the pulsating contractile organs. Weiss and Wang (Weiss, Wang, 1936) established this peristalsis (systole) of capillaries by means of capillaroscopy. Magnus observed the same phenomenon on a piece of intestine, on tissue culture according to the Carrel method.

Hagen noted changes in the diameter of the capillaries in different periods of the day, month, year. In the morning, the capillaries are more narrowed than in the evening, the general exchange is reduced. This explains the lowering of the internal temperature in the morning and its increase in the evening. In women, in the premenstrual period, the number of open capillaries increases, hence a more active metabolism and an increase in temperature. In the period between September and January, capillary spasms and numerous congestions are observed.

This is the reason for seasonal illnesses, including peptic ulcer disease in September, as well as in March.

Niko observed the effect of X-rays on the body by capillaroscopy at the Tübingen Medical Clinic. In cutaneous erythema caused by X-rays, Niko traced serum exudation through the capillary walls; after the termination of X-ray therapy, there was a massive decrease in skin capillaries. The ailments experienced after a series of sessions of X-ray therapy, the appearance of radio-beam dermatitis, were thus clarified as early as 1920. David (David) confirmed the observations of Nico. But no one for 32 years has thought to do capillaroscopy before using X-ray therapy for patients suffering from hyperthyroidism, renal failure, i.e. syndromes that are always accompanied by capillary weakness.

During treatment with digitalis (after appropriate preparation of the patient) and small doses of theobromine derivatives (not exceeding 0.5 g per day in two doses), there is a disappearance of atonic expansion of the venous loops of capillaries and postcapillary small veins, the disappearance of blood stasis, a decrease in capillary pressure (Weiss, Wang, 1936, and many others).

Capillary diseases: capillaritis (Fahr) or capillaropathy (Zalmanov) constitute the most important chapter in pathology. We have the right to assert that this is the basis of every disease process; without physiopathology of capillaries, medicine remains on the surface of phenomena and is unable to understand anything either in general or in particular pathology.

Classical neurology, with its almost mathematical accuracy of diagnosis, is powerless from a therapeutic point of view, because it neglects the blood circulation of the spinal cord, peripheral nerves and thus deprives itself of many means of therapy.

The extent of the lesions caused by local capillaropathy depends locally on the anatomical region. This was well proved by Müller (Miiller, 1922) with the example of Salvarsan. The reaction does not lead to serious complications if it is used on the genitals. When salvarsan is exposed to the initial segment of the aorta, swelling of the vase-vasorum and coronary vessels can lead to sudden death. Finally, in the central nervous system, it can lead to a very serious illness.

Periodic congestion or spasms of the capillaries of the fingers underlie the symptoms of "dead fingers", acrocyanosis, Raynaud's disease. Congestion or recurrent spasms in the organs of the labyrinth of the inner ear cause dizziness in Meniere's syndrome.

In patients affected by the so-called angioneurosis, instead of a normal picture, a real vascular storm in the capillaries, precapillaries and postcapillaries is established with a capillaroscope.

Some capillaries are highly atonic, dilated to a maximum in a state of stasis, and in adjacent areas the blood flow is much accelerated; atony and spasms can spread to arteries and veins. At the same time, there is a decrease or an excessive increase in the permeability of capillary membranes and a tendency to edema according to the Gansslen method from Tübingen, which consists in measuring the length of time required for the formation of a pustule after applying a few square millimeters of a plaster from a Spanish fly. Asthenics of tall stature most often have dilated convoluted capillaries, while at picnics, the capillaries are easier to break down.

Varicose veins often begin in the venous loops of the capillaries. In women complaining of vague scattered pains (occiput, shoulders, sacro-lumbar region), in whom no joint changes, no bone deformities, or signs of neuritis are found, it is often possible to feel induration in the muscles; then one must think of intramuscular urticaria, according to Quincke's suggestion. These innumerable microscopic hematomas around muscle fibers explain muscle pain better than the hypothesis of the formation of a gelatinous substance.

Ginselmann and Nettekorn observed diffuse capillary stasis in the skin, intestinal loops and uterus in eclampsia. This stasis is noted with convulsions and high blood pressure.

The old hypothesis of angiospastic anemia of the brain as the cause of eclampsia is thus objectively confirmed in capillaroscopy. Parrisius (Parrisius) stated significant changes in cutaneous capillaries in almost all cases of glaucoma and Meniere's syndrome.

In infectious diseases, vasomotor paresis affects not only arteries and arterioles, but also the entire capillary network. Hornstetter described capillary congestion in typhoid fever, Jorgensen in influenza. After a period of excitement, when the blood flow is still satisfactory, the stage of capillary paralysis sets in. All capillaries are equally dilated, filled with bluish-purple blood mass. Continuing observation for several minutes, you can make sure that there is no trace of blood movement. The same phenomena occur with typhus, scarlet fever, septicemia. Huber observed capillary paralysis in diphtheria. Von Heubner (1931) was able to experimentally induce the same capillary paralysis by means of gold salts.

When we observe how the hypertrophied heart surrenders, which has worked satisfactorily for a rather long time, we can explain the weakness of the myocardium, which is insufficiently irrigated with blood, by an increase in the gaps between the capillaries. Myocardial fibers became longer and thinner, while the formation of new capillaries, an increase in the number of open capillaries did not accompany an increase in the number and size of myofibrils; hence myocardial anoxemia with its consequences: myomalacia, proliferation of connective tissue, fatty degeneration.

Lack of oxygen is known to cause characteristic muscle pain. We now know that the flow of oxygen to the heart depends on irrigation of the vas-vasorum of the coronary arteries and on the percentage of oxygen in the blood. When the heart is overstrained, when the atmosphere is poor in oxygen, a decrease in the ST wave and deformation of the T wave appears on the electrocardiogram of even a healthy person in exactly the same way as in the case of angina pectoris.

Lack of oxygen always causes pain due to malnutrition of the myofibrils; the longer the oxygen deficiency, the more micronecrosis appears in the myocardium. The fusion of these micronecroses can result in a picture of myocardial infarction even without blockage of one of the branches of the coronary artery. Resting angina attacks are much more dangerous than a stress attack. Resting seizures indicate, in effect, long-term obstruction of the vase-vasorum of the coronary arteries.

Niko discovered changes in capillaries and increased capillary pressure 6 weeks after scarlet fever, when the rash had already disappeared. Kilin found that increased capillary pressure persists for quite a long time after the temperature has dropped. Patients in this category must be strictly monitored: they are easily endangered by glomerulonephritis. Ophthalmologists are well aware of the changes in the arterioles and capillaries of the retina during renal hematogenous diseases. Schleyer claims that acute hematogenous nephritis is always preceded by general capillaritis, toxicosis of capillaries of infectious origin. There is not a single disease with morphological changes, there is not a single functional disorder in which the state of the capillaries does not play a primary role. But, naturally, one should never forget about the relationship between the blood flow in the capillaries and other body functions.

You need to think about the interaction of all organs. Breathing, nutrition, excretion of each patient should be carefully studied, but one should not get confused in small details. It is necessary to establish a hierarchy of diagnostic indicators for each patient. The clinic should use laboratory and radiological data, but the clinic has the final say. The laboratory and the X-ray are experts, the clinic is the judge.

Capillary blood circulation. Rivers originate from many streams, the water of which is always in motion: rises, overflows the banks, lavishes underground irregularities, gives rise to streams, which multiply merge into shallow channels that feed large rivers. The movement of intermediate waters - the source of blood circulation - is a striking analogy to the headwaters of rivers. The arterial loop of the capillaries squeezes the plasma water through its walls. The venous loop absorbs water in the intermediate space washed by extracellular fluids, which affects the droplets of extracellular fluid and causes changes in its pressure. This is the real beginning of the circulation of organic fluids and, ultimately, blood.

Higher unicellular organisms, possessing - pulsating vacuoles, represent the first stage of intracellular fluid circulation. The extracellular fluid for unicellular organisms is the sea or river where they live.

The Tübingen School is credited with using capillaroscopy data in the clinic; it opened the great chapter of capillaropathy for the physiologist and physician. Unfortunately for the clinic, these works were not used by either physiologists or doctors. Only in France did Baruk and Racine become interested in the wonderful life of capillaries. They revealed significant capillaroscopic changes in all pathologically altered tissues, ascertained a violation of capillary circulation in various tissues in those suffering from a breakdown.

In his writings on mental illness, Luys emphasized that in melancholic people, cerebral blood circulation is reduced, while with manic excitement, the flow of blood to the brain is increased with a simultaneous expansion of blood vessels. The results achieved with regard to the treatment of melancholy with electroshock methods are obtained, according to Baruk, from an instant increase in blood circulation in the brain. This enhancement is achieved at the cost of too gross and dangerous effects on blood circulation and on the brain tissue itself.

Barouk, Racine, David and Lerouz experimentally showed that the use of folliculin causes a significant expansion of the vessels of the brain and blood flow to it. An attack of catatonia is accompanied by an unusual pallor of the face as a result of vasoconstriction. Barouk and Claude described orthostatic acrocyanosis of the lower extremities in catatonia, which can sometimes simulate arteritis obliterans. With catatonia, psycho-vascular, psycho-digestive, psycho-respiratory and other psycho-visceral synergies are observed. On the example of catatonia, one can understand that there is no single and stereotyped treatment even for the same disease.

Venous system and blood flow

Each violation of blood circulation causes a decrease in its volume intended for tissues, and reduces the supply of oxygen. Hypoxemia sets in. Each decrease in the volume of oxygen in arterial blood causes circulatory disturbances. And this fact is not sufficiently appreciated by cardiology.

Any decrease in the volume of respiratory function (pneumopathies, compression of the lungs by swollen lymph nodes, whooping cough, Hodgkin's disease, pulmonary tumors, retrosternal goiter, artificial pneumothorax, pleurisy), reducing the volume of alveolar air in the flattened alveoli and the number of erythrocytes in narrowed capillaries only causes hypoxemia in all organs, but also deprives the myocardium and the muscular system of the arteries of the oxygen supply necessary for their normal activity.

At the same time, the accumulation of carbon dioxide and other non-oxidized or insufficiently oxidized metabolites occurs in the circulating blood. Hence - the constant intoxication of the myocardium and the muscular system of the arteries. Any disturbance in the work of the respiratory center during intoxication and infections causes a decrease in the oxygen saturation of the circulating blood. Any changes in the acid-base balance in the blood (hyperglycemia, hypoglycemia, azotemia, hyperchloremia, hypochloremia, acetonemia) affect the absorption of oxygen and cause hypoxemia.

Each venous congestion (arrest of venous circulation) in the pulmonary circulation (mitral stenosis, cyanotic disease), as well as a decrease in the mobility of the diaphragm as a result of an increase in the volume of the liver and spleen (pneumothorax, frenectomy) cause tissue hypoxia. Potassium cyanide leads to instant tissue hypoxia and death.

Tissue and cellular hypoxia can occur despite the complete health of the cardiovascular apparatus. When dealing with a patient suffering from a cardiovascular disorder, you should never be limited to the heart, electrocardiograms, you must carefully investigate other sources of hypoxia: lungs, blood, diaphragm mobility, measure the volume of the liver and spleen in order to approximately establish the volume of circulating blood.

Venous congestion in the varicose veins, in the portal vein, in the blood depot - in the spleen and in the liver sensitively reduces the volume of blood brought to the heart by the vena cava in each diastole. Since the volume of blood circulating in the arteries is always equal to the volume of blood circulating in the veins, any decrease in the flow of venous blood will be followed by a decrease in the volume of blood pushed out by each contraction of the heart.

The law of equilibrium between the volume of arterial blood and the volume of venous blood is the main basis of all hemodynamics. If, within only one hour, the flow of venous blood would decrease by only one gram at each diastole, then there would be a shortage of 70-80 g per minute, i.e. from 4 to 5 liters per hour (80 x 60 = 4800), the heart would be empty. The heartbeats would stop. The formula “primum modens, ultimum mofiens” should not be applied to the heart, but to venous blood, the continuous flow of which is the true river of life. The main engine is the flow of venous blood, while the miraculous mechanism of the heart is a secondary factor.

And therefore, not without reason, for 30 years we have been demanding an end to the abuse of intravenous injections, which injure, cripple and deform the walls of the veins and worsen the composition of venous blood, the main engine of life.

The volume of cardiac blood supply could be compensated by an increase in the number of cardiac systoles, but then tachycardia would be accompanied by a decrease in the amount of blood in the pulmonary alveoli and a decrease in the time of contact of hemoglobin with parenchymal cells. Tissue and cellular hypoxia would come. Another important conclusion follows from this. The inflow of venous blood to the heart cavity causes a sharp stretching, rapid expansion of the heart cavities and should be considered as an additional factor, quite important among others.

Any stretch of elastic, contractive tissue is accompanied by contraction: systole. The energy required to cause myocardial contraction comes, on the one hand, from the rhythmic and continuous inflow of venous blood through the superior and inferior vena cava and arterial blood through the pulmonary vein, and on the other, from a sharp stretching of the myocardium. The heart is only a motor, receiving energy from a single fluid that is being poured in and must be pushed out. The heart is an engine running for 70 or 80 years.

Insufficient attention was paid to the importance of venous blood flow to the heart cavity. Henceforth, consider each venous congestion as an important factor in the weakening of the heart and hypoxia.

The volume of circulating blood is the dominant factor in a well-balanced blood circulation. A decrease in the volume of circulating blood, an accumulation of blood in the depot (in the liver, spleen, in the portal vein network) is accompanied by a decrease in the volume of blood that arrives at the heart and which is thrown out by each systole.

A sharp decrease in blood volume causes acute heart failure, cardiovascular collapse is a sharply manifested syndrome characterized by an extreme breakdown with cyanosis and a drop in body temperature, with a fast and weak pulse, with a sharp drop in blood pressure. Collapses are known after severe bleeding, during acute infections, after serious surgical interventions, in severely burned patients, with acute peritonitis with perforation, in the last period of severe diabetes, after severe vomiting and choleroid-type diarrhea, collapses are also observed in Addison's disease and severe uremia. The collapse is caused by very little blood flow to the heart cavity. The volume of fluid becomes insufficient to cause distension of the myocardium, accompanied by a contraction of the heart. I.P. Pavlov (1894) at the same time stated a large accumulation of blood in the plexus of the portal vein.

The retention of toxic metabolites in the blood and in extracellular fluids can lead to distension of small veins and capillaries, accompanied by general venous congestion. The toxicity of metabolites can further alter the permeability of the capillary membrane. When the walls of the capillaries expand, some of the plasma leaves the capillaries, the volume of circulating blood decreases, the blood flow slows down and the heart receives a reduced amount of blood. These processes can be localized in any area of ​​the body, but they can also become widespread. In the latter case, we have a general stagnation of blood in the abdominal cavity, this is a very dangerous collapse. A decrease in blood volume is naturally always followed by severe tissue and cellular hypoxia. How many severe cases of so-called cardiac decompensation attributed to myocarditis and myocardodystrophy, how many cases attributable to arrhythmic hyposystoles, are caused by insufficient flow of venous blood to the heart cavity.

Modern neurophysiology has fully adopted Pavlov's teaching, which proved that the mechanisms of inhibition in the brain are not the result of exhaustion, i.e. passive processes. Brain inhibition is rather an active, dynamic phenomenon.

When you open or close a window, some energy consumption is required. In the same way, by lighting a candle or extinguishing it, you make an effort, you expend energy. It seems to me that we must admit that the periodic expansion of the heart during diastole is the same active process as the periodic inhibition of the brain. It is necessary to recognize the importance of venous blood for hemodynamics.

Continuing to compare the nervous and venous systems and taking into account the venous valve system, remarkably analyzed and explained by Dr. Delater (1932), we allow ourselves to expand and supplement his views on the role of venous valves. We could regard each venous segment between the two valves as a small venous contractile heart pushing venous blood with remarkable dynamism into the right ventricle.

Prof. Dubreuil already in 1931 at a general meeting of the Paris Anatomical Society argued on the basis of numerous histological details the likelihood of the propulsive function of the veins. Huchard (1913) foresaw the existence of countless peripheral hearts. But it was mostly Delater's idea. It was he who, thanks to his keen imagination, always remaining a thinking anatomist who knows how to compare, enriched our knowledge and illuminated the primary factor, which until him remained unclear in the field of hemodynamics.

Cardiology did not honor Delater's great discovery. She preferred to mark time in the jungle of electrocardiograms. Delater (1932), stating the venous function of dynamic blood pushing, was surprised that the mechanism of this pushing could not be captured with the help of our devices. He never had a chance to meet with Krogh! For Delater, the capillary network was a braking dam. For the followers of Krogh, the capillary network is an enormous source of propulsive energy.

The veins receive blood from the venules, and the latter from the venous loops of the capillaries. Capillary systole, as shown by the school of prof. Müller in Tübingen, are a source of blood circulation, just as streams supply water to large rivers.

Imagine the contraction and expansion of capillaries over a hundred thousand kilometers, the power of their continuous activity, water exchange between capillaries and extracellular fluids, a continuous change in capillary volume - and you will find expanded hemodynamics, the flow of life, which begins in the contracting capillary membranes, spreads to venules and veins with their valves and reaches the right ventricle.

Phlebology, i.e. vein science is recognized as the most important field of cardiology, and this latter is intended to leave the narrow technical framework in order to become familiar with such phenomena as anoxemia, renal failure and the pathophysiological role of the skin.

Closed and free circulation. Internal circulation of fluids in organs is free circulation. Its volume without special vessels is about 9-11 liters. The closed circulation of the fluid that fills the blood and lymph vessels is 7 liters: 5 liters of blood and 2 liters of lymph.

To ensure the secretory functions of the mucous membranes of the mouth, tongue, esophagus, glands of the digestive tract, in order to ensure the irrigation of cells and tissues throughout the body, it is necessary that the blood and lymph (closed circulation) receive a continuous flow of extracellular fluids through the walls of the venous loops of the capillaries.

Without this influx, blood and lymph would lose their normal composition, their homeostasis - (Cannon). This influx must be regulated every minute with precision beyond the imagination of the most famous biochemists. One should never forget about the continuous circulation between blood and lymph, on the one hand, and extracellular fluids, on the other. The same applies to the exchange between intra- and extracellular fluids.

To help the body restore the flow between closed and free circulation, there is no therapy other than hydrotherapy with its immense possibilities. Therapy without hydrotherapy is a dried out therapy that hides its impotence under a mountain of poisonous or useless drugs. Of course, hydrotherapy must be accompanied by a regimen that helps to correct violations of closed and free circulation.