(From the Physiological Laboratory, Cambridge.)

Transcription

1 THE GASEOUS METABOLISM OF THE SUBMAXIL- LARY GLAND. BY JOSEPH BARCROFT, M.A., B.Sc., Fellow of King's College, Cambridge. (Nine Figures in Text.) Part I. On Methods, with a description of an Apparatus for Gas Analysis. (From the Physiological Laboratory, Cambridge.) IN the winter of 1897 I commenced a comparison of the gases in the venous blood emerging from the submaxillary gland with those of the arterial blood. Since it is necessary to be content with much smaller quantities of blood than are usually available for accurate blood-gas determinations, I have found it necessary to make some improvements in the analytical methods. I have also made some preliminary investigations concerning the influence upon the blood-gases of anaesthetics, and the various expedients for rendering the blood less pronle to clot. Part I. given here deals with these points. A question arises as to how far the venous blood is comparable, volume for volume, with the arterial blood during stimulation of the chorda tympani nerve. The answer to this question will form the subject-matter of Part II., while Part III. will be an account of the actual results I have obtained on the main issue of the research. The gas-pump. Throughout the research I have used a Toepler pump and have found it satisfactory in every way. Having tried pumps of different sizes, I have found the most satisfactory to be one with a chamber 20 centimetres long and 4-5 centimetres in diameter. This instrument is shown in Fig. 1 and only requires description in two particulars. Firstly, I have introduced a couple of permanent rubber joints (Fig. 1, a and b) covered with mercury jackets in order to reduce the strain on the pump. Even better than a rubber joint for this purpose I have found a helix of glass tubing. Secondly, in order to get rid of the great quantity of aqueous vapour which comes over with the gases I have introduced a special form of drying apparatus. PR. xxv.

2 266 J. BARCROFT. I II I II I JWrA&%m I I II I I II I I I I I -k

3 ANALYSIS OF BLOOD GASES. 267 This consists of a towerf containing pumice saturated with suilphuric acid, at the bottom of the tower is a bulb p which is filled with acid. The gases are led into this bulb through the tube m and give up much of their water to the acid in the bulb g. When this acid is spent it can be removed into a second vacuous bulb p at the side by opening the tap between the two and raising the reservoir r with the tap h also open. Fresh acid can be allowed to enter at the top of the tower, and if this contains no air in solution, the whole arrangement will have saved the labour of making a fresh vacuum. The mercury reservoir d is suspended from a pulley in the ceiling and counterbalanced. A three-way tap c leads to a filter-pump, saving much labour in the making of the preliminary vaciuum. The receivers and measurintg burette. The characteristic feature of the apparatus is that it is all in one piece. In the usual forms of apparatus the various parts were detachable. This necessitated the making of certaini joints during the experiment, with the corresponding risk of the inclusion of small quantities of air in some part of the apparatus. This is especially the case with those pumps in which the joints are simply pieces of uinprotected rubber tubing. In the apparatus under discussion there are no joints. The burette in which the blood is measured, shown in Fig. 8, is blown on to the receiver shown in Fig. 2. The receiver is blown on to the tube mn (Fig. 1) leading to the pump. The whole apparatus when set up presents the appearance shown in Figs. 6 and 7. When the experiment is finished the various parts are cut from one another in order that they may be washed. Rubber joints were not used for the following reasons. There is a danger of breaking the apparatus in binding such joints with wire, and unless they are bound with wire they are uncertain; it is difficult to localise a leak in a rubber joint, whilst this is easy in the case of tap, and is not easy to drive the blood completely out of them. Perhaps the apparatus will best be understood if a description is given of its actual working. The broad tube C, Fig. 8, is attached to a T cannula in the jugular vein (after all the possible paths for blood to enter the vein have been tied, except those coming from the submaxillary gland). The burette has been filled entirely with mercury. The stopper at the head of the burette (shown in Fig. 9) is turned so that the tube F communicates with C. Atny air that might have been in the cannula and a little blood are allowed to run into the burette, and then the stopper is turned through 90 so that F becomes blind. 20-2

4 268 J. BARCROFT. CZ ul. 0 P".L- G~~~~

5 ANALYSIS OF BLOOD GASES. The tap H' is then opened and the blood and air are expelled. The apparatus is now ready for the collection of a sample; F is turned back to the tube C and blood is allowed to run into the burette till sufficient has been abstracted, say 8 c.c. The stopper is then turned through 90 again. The quantity of blood collected is read off on the graduated scale and the stopper F turned so that it communicates with the tube D, the bore of which is 2 mm. and which leads to the vacuous receiver. This receiver is shown in Fig. 2. The whole system for purposes of description will be termed a " receiver." The one depicted consists of six " chambers," each chamber having three " bulbs " and being of the form supplied with Leonard Hill's apparatus'. The capacity of the " chamber " is about 200 c.c. At the top of each chamber there is an ordinary two-way tap (Fig. 5), at the bottom there is a three-way tap, shown in two positions (Figs. 3 and 4). The tube D (Fig. 8) of the measuring burette is continuous with the tube ef (Fig. 2), which may be called the " blood-main" so that the blood shall enter at f This tube is of the same bore as the tube D from the burette, namely 2 mm. From the figures it will be seen that when the tap is turned with the stopper parallel to the "blood-main" fluid can run through the tap along the main," whilst if the tap is turned with the handle perpendicular to the "nain " (as shown in Fig. 4) any fluid reaching the tap must run up into the "chamber." It will thuis be obvious that if, with one hand the stopper of the burette be turned so that F becomes continuous with D (Figs. 8 and 9), and with the other the tap b3 be turned into the perpendicular position (b2 and b, being in the position shown in Fig. 2), the blood will all run from the burette into the chamber A3 and mercury will follow it, washing the "blood-main" till b3 is closed. With a good vacuum in A3 the whole chamber would be filled with froth, were not a hot sponge held on the top in the manner described by Leonard Hill. When it is wished to pump off the gases the tap at the top of A3 is opened and they are allowed to expand along the wide tubing (cd, Fig. 2), called the " gas-main," joined to m (Fig. 1) and so into the pump. There remain to be described two details sbown in the drawings: Firstly, in Fig. 2 there is a bulb K. It is necessary for the following reason. The quantity of blood read off on the burette-scale is not exactly that which enters the chambers. The scale starts from an arbitrary zero. It is a matter of calibration with each separate 1 This Journal, xvii. p

6 270 J. BARCROFT. T6

7 ANALYSIS OF BLOOD GASES. 271 burette (of which some five or six have been used at different times) to find out what constant must be added to the reading in order to get the actual quantity of blood entering the "chamber." This constant, however, assumes that there is a film of blood in the " main." In order therefore to get the reading for the chamber b6 (which is used first) uniform with the rest, a film must be made by allowing a little blood to go through the " blood-main" into the bulb K. Secondly, in Fig. 6, there are shown, in various positions, bags round the lowest bulb of each chamber. They are made of water-proof material and are stretched at the top on elliptical hoops of copper wire. Hot water is put into these to boil the blood whilst the gases are being extracted. An a.i'i.i,''i Fig. 7.

8 272 J. BARCROFT. iff C p Fig. 8. B Fig. 9.

9 ANALYSIS OF BLOOD GASES. 273 alternative to their use is that of warm sponges, which is more convenient if an attendant is at hand to hold them. Gas analysis apparatus. Throughout the research I have used the gas analysis apparatus described by Haldane'. The accuracy of the methods employed. Perhaps the best test of the accuracy of the apparatus which has been described is furnished by the figures given for the analysis of several samples of the same defibrinated blood. I append two such analyses, the former made in December, 1898, the latter in February of this year. Ten cubic centimetres of blood were taken in each case. a b c Range of Error I. C c.c c.c c.c *4 N *7 1-9 *2 II. C c.c. 52'6 c.c c.c. * * N *8 for every 100 c.c. of blood. * On the assumption that the excess of nitrogen is due to air. The first series of analyses represents the ordinary working error more closely than the second, though in many analyses the oxygen values have come out wonderfully concordant, as, for instance, in Exp. XI., where blood was withdrawn from the aninmal on two occasions, the samples C and B being withdrawn 18 minutes after the samples A and B. It must, however, be remembered that there was an interval of a minute or so between the withdrawal of C and D and again between A and B, so that it is not possible to argue that the composition of the blood in each case was exactly the samie. The figures however are A c.c. C 19-72c.c. { B D for every 100c.c. of blood. A fair indication of the amount of air which leaks into the apparatus is furnished by the nitrogen readings. These will be found in a great proportion of experiments to be between 1x5 c.c. and 2 0 c.c. per 100 c.c. of blood. In time the glass taps get pitted, and when the nitrogen readings get at all frequently over 2-5 I have either got the taps reground or had the receivers rebuilt with new taps as the occasion required. 1 This Journal, xxii. p

10 274 J. BARCROFT. Apart from analyses of blood the apparatus has been tested in various ways. Perhaps the most stringent test was one applied from 9 p.m. on October 22, 1898, till 6 p.m. on October 27. For almost five days the two receivers were left vacuous. Each chamber was then exhausted separately, with the following result. No. of chamber VI V2 V3 V4 V5 Air extracted *2 c.c. 1 c.c. *3 c.c. 0 c.c. *12 c.c. In each of the chambers A, A2, etc. (Fig. 6), about two cubic centimetres of water (previously deprived of its air by boiling in a vacuum) was passed exactly as blood would be in an experiment. The chambers were then exhausted, with the following result. A1 A2 A3 *2 c.c. 0Oc.c. -0c.c. It is always well to make the vacuum in the apparatus the night before an experiment, and to test it in the morning. This has been done in the majority of experiments performed on the submaxillary gland. A precaution always observed has been to put a little mercury in each chamber before the vacuum has been made. This at once shows whether there is a leak in any of the three-way taps, and also insures that there is no air left in the tubing of any of the taps or in the " blood-main." After testing a number of lubricants I have found the best to be one fuirnished by Messrs C. E. Muller and Co. (who have made my apparatus); it is a mixture of vaseline and india-rubber. It need hardly to be said that the efficiency of the apparatus depends largely uipon its cleanness; whenever an experiment is finished I allow a hot solution of caustic soda to be sucked into each chamber, filling it as nearly as possible. This remaitns in it over-night, in the morning the receivers are emptied, cut off the pump and off the burettes, and washed first with water, then with acid alcohol, then ordinary alcohol, and lastly with ether. In a comparison such as that of the venous blood coming from the resting gland with that coming from the active gland (from which the blood may flow seven or eight times as rapidly) it is necessary to know exactly how long each sample of blood takes to collect; for this purpose I have had an electrical contact fitted on to the burette, which is made by the turning of the stopper so that a signal marking oni a drum inay be pulled down during the interval of time taken for the collection.

11 ANALYSIS OF BLOOD GASES. In the analysis of the gases, in the measurement of the blood, and in the measurenment of the time, my object has been to reduce an error to less than 1 per cent. of the quantities measured. Taking the range of error of oxygen and carbonic acid as about 3, and the deviation from the average as *15 c.c. per 100 c.c. of Mlood, it will be seen that if there are 15 volumes per cent. of oxygen this standard has just been reached, whilst the error for the carbonic acid is well beneath the limit. To the same end the measuring burettes are graduated to I th of a cubic centimetre, and with careful manipulation and the electrical time marker, the error in the time mneasurement should be very small. The coagulability of the blood. I have found the intravenous injection of leech extract' to be the most efficient method of preventing coagulation in the cannula through which the venous blood is collected from the gland. Peptone I have not used, since it produces lowering of the bloodpressure and causes the gland to secrete saliva. Anid Lahousse' has shown that peptone very materially alters the quantity of carbonic acid in the blood. Although Dickinson" contends that the virtue of leech extract as a non-coagulant is due to its containing albumose, I lhave been uinable to trace any sitnilarity in the general physiological effects of soltutions of the two when injected. Haycraft4 has shown that leech extract produces no great effect upon the blood-pressure. This I have verified (Exp. III.). Leech extract does not cause a flow of saliva, nor greatly modify the quantity of saliva secreted during stimulation of the glanid by the chorda (Exps. III., IV. and X.). In Exp. X. the gases in the arterial blood were determined before and after the injection of leech extract, with the following result. Sample CO2 0 2h. lo JA c.c c.c. {B Irnjection of leech extract. c c.c. C { D c.c. for every 100 c.c. of blood. 1 Skand. Archiv fur Phys. ii. p Archiv fur (Anat. und) Physiol. 1889, p This Journal, xi Proc. of the Roy. Soc. xxxvi. p

12 276 J. BARCROFT. The result of Exp. X. is fully borne out by Exp. XI. as follows: Time Sample CO2 02 N p.m. II c.c c.c. 2-7 c.c Extract injected (32 leech heads in 40 c.c.) 2.5 III. 36z IV V l9-5 3* VI for every 100 c.c. of blood. From these experiments it would appear that the figures drawn from one such as Exp. VI. are deceptive. These are Time Sample CO2 02 N Injection of extract (32 leeches in 90 c.c.) II c.c c.c c.c III for every 100 c.c. of blood. Exp. XI. would give a sitnilar result for the CO2 if only samples III. and VI. were compared. The interval of time between samples II. and III. of Exp. VI. is 48 minutes, and that between samples III. and VI. of Exp. XI. is 50 minutes. In view of the figures just given it is necessary, in experimenting on the gland, to collect the arterial and venous bloods synchronously when the gland is in the resting state, since the collectioni of the latter takes some minutes. When the chorda is being stinmulated the interval of time between the collection of the samples of arterial and venous blood should be as short as possible. If the stimuilation takes place immediately after blood has been collected from the resting gland, the sample of arterial blood is used for comparison with thie venous blood both from the resting and from the active gland. Leech extract has the disadvantage of being a little uncertain in its action. Haycraft1 states that one dog out of every six is immune to the action of leech extract. On several occasions I have found the extract to be without effect. A more certain expedient for preventing coagulation is that of bleeding the dog several times in succession, whipping the blood and injecting it back into the vessels. This takes a considerable time, and as it cannot be done till after all the dissections have been made, 1 Proc. of the Roy. Soc. xxxvi. p

13 ANALYSIS OF BLOOD GASES. including the exposure both of the chorda tympani and the gland itself, the delay incurred is fatal to the method. A modification of this plan has however been tried with some success, and will be a useful check on the method of injecting leech extract. The method is to employ two dogs, one of which (A) is to be used for the experiment on the gland. When the necessary dissections have been made, the second dog (B) is bled into a large beaker and the blood is whipped with feathers, whilst it is kept warm by means of a water-bath. When the fibrin has been extracted, the dog A is bled to an equal extent and the defibrinated blood of B allowed to flow into it. This method was tested in Exp. II.; the tracing showed a good blood-pressure after the operation, but thle quantity of oxygen in the arterial blood after it had been (defibiinated was very small. The whipped blood fromn B was put into A at 4.46 p.m. Time Sample CO2 02 N2 5.1 I c.c. 9 9 c.c. 1'5 c.c II III for every 100 c.c. of blood. 277 Ancesthetics. In some of the experiments already cited the quantity of CO2 in the blood is abnormally high. This has equally been the case, whether coagulable or non-coagulable blood has been used. It is therefore not due in any way to the blood clotting in the chambers. For example in Exp. III.: C02 in normal blood = 58 6 c.c. CO2 after injection of leech extract = 541 c.c. Again, in Exp. IV., where a sample of blood was received into an empty receiver and another into one containing 2 c.c. of 1 0/0 potassium oxalate solution the following results were obtained: C02 in empty chamber = 57-1 c.c. for 100 c.c. of blood. CO in oxalate chamber = 56 2 c.c. It seemed possible that this increase in the C02 in arterial blood was due in some way to the anasthetics1. The two anaesthetics used have been morphia and A.C.E. mixture. It did not appear probable at first sight that the rise in Though Paul Bert under deep chloroform anvesthesia gets only 44 volumes 0/0 Hill and Nabarro out of a large number of experiments done under morphia get as the average number in 52 samples of arterial blood. They do not state how much morphia they used or how long their experiment lasted (this Journal, xvm. p ).

14 278 J. BARCROFT. was duie to chloroform. The effect of chloroform on the blood gases is discussed by Guinard in the Dictionrnaire de Physiologie, iii. p. 623, from which it appears that different observers, and even the same observer (Paul Bert), have obtained absolutely contrary results, in the endeavour to arrive at the effect of chloroform upon the blood gases. While Paul Bert finds that after chloroform there is a fall in oxygen and rise in 002, Arloing gets the opposite result. If Arloing's figures are correct the effects on the blood gases would be so trivial as not to cause any abnormality. Guinard' considers that whatever the effect of chloroform may be on the blood gases it is produced by altered metabolism as well as by altered respiration. In Exps. I., III., VI., VII. the arrmount of CO2 in the arterial blood was in all cases abnormally high. In these experiments there occur samples of arterial blood from anitmals under the ordinary conditions of experiment in which the animal has had morphia and chloroform and has lain some time upon the dissecting table. The results for the 0O2 under these circumstances are as follows: blood Exp. I Dog given morphia, then chloroform C02 in arterial blood (mean of these samples) Exp. III Dog given morphia, then chloroform Sample I. arterial blood CO2 = 58&6 ExP. IV Dog given morphia, then at 2-5 chloroform Sample I. arterial blood C02 = 57-1 Sample II. arterial blood (oxalate in Exp. VI Exp. VII per 100 c.c. of = 47.4 c.c. receiver) C02 = 56-2 Dog given morphia. Dog given chloroform. Samiiple III. (after inijection of leech extract) Sample II. do. Dog given chloroform. Dog given morphia. Sample III. arterial blood C02= 52-7 C02 = 54-3 C02 = 46-4 Whilst the above figures show what amiiount of CO2 exist in the arterial blood of a dog " under the ordinary conditions of experiment," 1 Richet's Dictionnaire de Physiologie. Art. Chloroforme.

15 ANALYSIS OF BLOOD GASES. I may add that in no dog which I have investigated some time after the administration of morphia and chloroform was there less than 46 4 c.c. of CO2 in every 100 c.c. of arterial blood, unless the blood had been artificially modified, by some process such as whipping or artificial respiration. An analvsis of defibrinated blood was made in one bulb of the apparatus used in Exp. VI., lest the high CO2 readings should be duie to experimental error, with the following result: C02= 34-8 c.c., 02 = 16-1 c.c., N2 = 2-0 c.c. for every 100 c.c. of blood. It seemed then that the high CO2 value might be due to either the chloroform or the morphia Exp. VII. was therefore performed in which the dog was given chloroform without morphia. The chloroform was given at Twenty minutes later the first sample was taken for analysis. The second sample was taken at At 2.50, 8 c.c. of 2 p. c. solution of morphia were injected and after some time a third sample of blood was taken. The results of the analyses are as follows: Sample I C02=38'4c.c. 0 =17-4 for every 100c.c. of blood. Sample II C02= =18-6 Morphia C02= 46-4 Sample III. 0 = 18-4 The experiment shows that a gradual rise of C02 takes place during the conditions of experiment. It does not however show whether the chloroform or the morphia has the greater effect, nor does it suggest whether Guinard's contention is correct', viz., that a rise in the CO2 in blood is due to altered respiration or to some definite action of the anesthetics on the system. It would seem however that the rate of respiration has a considerable effect upon the blood-gases, for between the withdrawal of samples III. and IV. of blood, the dog was subjected to twenty minutes of brisk respiration with the result that the 002 dropped from 46-4 to 18-9, and the oxygen rose from 16-4 to Richet's Dictionnaire de Physiologie, iii. p

16 280 J. BARCROFT. Supporting the results of Exp. VIII. is that of Exp. IX., in which the dog was andesthetised with chloroform only, the respirations became very rapid and three samples of blood were taken immediately from the carotid artery, the mean value for the CO2 was only volumes per cent. In order to discuss the action of chloroform two factors must be taken into account. The initial reduction in the amount of CO2 due to quickened respiration while the animal is being anmsthetised and the more lasting effect during anaesthesia which causes a rise of CO2. I have not pursued the question further, though I hope to do so at some future time. The immediate object was to obtain arterial blood in which the quantity of 002 was not abnormally high at the end of two or three hours' dissection under anaesthetics; this can be done by giving artificial respiration. APPENDIX. In the following additional details are given with regard to some of the experiments. Exp. II. Analysis of blood-gases after defibrination and transfusion. 2.0 Morphia to dog A Chloroform to dog A Bled dog B under chloroform Commenced bleeding dog A. A was bled till blood ceased to come Whipped blood from dog B injected into dog A. 5.1 Sample I. of blood taken from left femoral artery Sample II. as above Sample III. as above. 6.5 Sample of blood taken from carotid. This sample of blood was not clotted on the following day. Analysis of gases. In 100 c.c. of blood. Sample I. Sample II. Sample III. C02=46-5 c.c c.c c.c. = = N2 Exp. III. Analysis of blood-gases after injection of leech extract. Effect of leech extract on irritability of gland Morphia given. Weight of dog 10 kilos. Leech head extract. 20 heads to 50 c.c. NaCl solution Sample I. for gases from left femoral artery. Amount=8-85 c.c c.c. of leech extract injected Sample A of blood for clotting.

17 ANALYSIS OF BLOOD GASES No increased flow in cannula in Wharton's duct-gland responds fairly to stimulation of chorda Sample B of blood for clotting. 4.3 Sample C. Blood was very thick and clotted almost at once. 4.7 Sample B clotted Sample II. of blood. Barometer 758 mm. Thermometer 210 C. Sample A not clotted on following day. Analysis. Sample I. Sample II. C02=58-6 c.c c.c. 02 = N2 = for every 100 c.c. of blood. Exp. VI. Ef'ect of leech extract on blood-gases and coagulation Morphia 5 c.c. Weight of dog 7 kilos Chloroform to c.c. of leech extract injected (32 leeches to 70 c.c.) Sample I. from femoral artery. Amount=9 1 c.c Sample A of blood Sample B of blood Sample C of blood Sample II. as above. Amount=9 0 c.c Sample D Sample E Sample F None of the Samples A-F had clotted, though the later ones had a film of coagulation on the glass. Barometer 760 mm. Thermometer 200 C. None of the Samples A-F had coagulated on the following morning. Analysis of gases. Sample I. Sample II. C02=52 7 c.c c.c. 02 = N2 = for every 100 c.c. of blood. Exp. VIl. Efect of chloroform, morphia and artificial respiration on blood-gases Gave dog chloroform without morphia Sample I. of blood Sample II. of blood c.c. of 2 O/0 solution of morphia injected Respirations 12 per minute Sample III. of blood Artificial respiration 1 per sec. 5.5 Sample IV. of blood. 5.6 Artificial respiration stopped. Sample IV. of blood was peculiar in colour (by gas-light), looking as though some Chinese white had been mixed with the blood. 21 PH. XXV.

18 282 J. BARCROFI. Thermometer Analysis of gases. Sample I. Barometer 762 mm. Sample II. C02=38-4.c.. C02=43-6 c.c. 02 =-184 2coair=r17t3 d 02 =20 3 corrected= 18-6 c.c. N2 = 4 5 N2 = 8-4 Sample III. Sample IV. C02=46 4 c.0. C02= =19.5 corrected=18-4 c.c. 02 =21-8 corrected=21 4 c.c. N2 = 6-3 N2 = 3 2 Exp. X. Effect of leech extract on blood-gases and on flow of saliva. Dog, 7 kilos. Cannula in Wharton duct; dissect chorda tympani, cannula in femoral artery and femoral vein. 2.3 Chorda stimulated for one minute. Flow of saliva= 145 divisions. 2.7 Sample of blood drawn, clotted in seven minutes Sample I Sample I Injection of leech extract, 30 leeches in 50 c.a Sample III Sample IV Stimulated chorda, saliva in one minute=175 divisions. Thermometer 220. Analysis of gases. Barometer 764 mm. I. II. III. IV. C '722 cubic centimetres per 100 c.c. of blood.