Title STUDIES ON THE VISCEROGENIC REFLEXES. Author(s

Title
Author(s)
Citation
Issue Date
URL
STUDIES ON THE VISCEROGENIC REFLEXES.
Watanabe, Yutaka
日本外科宝函 (1954), 23(1): 38-57
1954-01-01
http://hdl.handle.net/2433/206061
Right
Type
Textversion
Departmental Bulletin Paper
publisher
Kyoto University
38
おTlTDIES O N T H E VISCEROGENIC REFLEXES.
F
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by
YUTAKA 九
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3〕
INTRODUCTION :
For e
x
p
e
r
i
m
e
n
t
a
ls
t
u
d
i
e
so
fs
e
n
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o
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y nervous pathways i
na
n
i
m
a
l
s
, we n
e
e
d
o
b
j
e
c
t
i
v
e
,o
b
s
e
r
v
a
b
l
e and c
o
n
s
t
a
n
ti
n
d
i
c
a
t
o
r
s
. T
h
e
r
e
f
o
r
e
,Iu
s
e
da
si
n
d
i
c
a
t
o
r
st
h
e
v
i
s
c
e
r
o
m
o
t
o
rr
e
f
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e
x
, vomiting r
e
f
l
e
x
, vasomotor r
e
s
p
o
n
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e
s
,i
n
h
i
b
i
t
o
r
y r
e
f
l
e
xo
f
i
n
t
e
s
t
i
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a
l movement and change o
fr
e
s
p
i
r
a
t
i
o
n
. R
e
c
e
n
t
l
y
, CHUJI KIMURA and
KAZUMASA OHBAhaved
i
s
c
o
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e
r
e
damethodc
a
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s
i
n
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i
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e
r
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lpaiαinhumanb
e
i
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s
:
i
n
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e
c
t
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o
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fv
a
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o
s
t
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m
i
n(
e
s
e
r
i
n
)a
c
e
t
h
y
l
c
h
o
l
i
n (ACH)s
o
l
u
t
i
o
ni
n
t
ot
h
ew
a
l
lo
ft
h
e
a
l
i
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e
n
t
a
r
yc
a
n
a
l
. S
o
,a
ss
t
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l
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st
oa v
i
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s
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e
dt
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sACH-method a
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e
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a
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t
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, such a
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e
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.
1
. CHANGES OFRESPIRATION.
The t
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d on a kymogramm d
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t
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d were :(
t
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,(
3
) dropping o
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ti
n
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ot
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ew
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l
lo
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h
ei
n
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e
s
t
i
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e
.
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e
s
u
l
t
so
f experiments:
6
:
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e
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f
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e
rACH s
o
l
u
t
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n was droppedonap
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n
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n
a
lw
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o
rr
a
b
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es
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e became s
p
a
s
t
i
c
, and t
h
e curve o
fr
e
s
p
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r
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t
i
o
n showed a
p
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e
a
,
s
u
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e
r
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i
a
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rd
e
e
pr
e
s
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rh
y
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e
r
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e
a
.Others
t
i
m
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l
icausedalmostt
h
esame
changes o
fr
e
s
p
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r
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t
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o
n
.(
F
i
g
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.
)
The r
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t
so
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e experiments on r
e
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p
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e
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f
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n
gv
a
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e
r
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e
t
r
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n
k
sa
r
e shown i
nt
a
b
l
e1
,2and3
. From
myexperiments o
fvagotomy andt
r
a
n
s
e
c
t
i
o
n
o
ft
h
es
p
i
n
a
lc
o
r
da
tt
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el
e
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e
lo
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et
h
o
r
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i
c
f vagotomy and p
o
s
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r
'
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rr
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g
m
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t
s
, ~r o
. R
e
s
p
i
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nc
u
r
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e
. ACHr
n
.
i
zotomy, we can assume t
h
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t some o
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F
i
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a
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iando
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l
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e
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nt
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e
r
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o
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o
o
t
sa
tTh3-L3,mostlyTh6-3.
.
ugh t
h巴 s
四
3
9
STUDIESC
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e same stimulus a
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Using t
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ostudy a
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t
ss
i
. INTESTINAL INHIBITORY REFLEX
3
.
a
l
u
t
s
i
lf
a
c
e
s who had f
t
n
e
i
t
a
np
di
e
i
d
u
t
e was s
n
i
t
s
e
t
n
f the i
The moflity o
e
c
i
f
i
r
o
e
h
t
o
lt
a
t
s
i
r the colon 15 50cm. d
e ileum o
h
ot
t
n
di
e
t
r
e
s
n
A baloon was i
ekymogram.
h
e was recordedont
n
i
t
s
e
t
n
f the i
yo
t
i
l
i
t
o
, and m
a
l
u
t
s
i
lf
a
c
e
f the f
o
s
u
o
c
u
esubm
h
nt
di
e
t
c
e
j
n
ACH wasi
l
a
c
e
ef
h
ft
eo
c
i
f
i
r
eo
h
e around t
u
s
s
i
t
n
i
e
h
t
d
e
w
o
h
s
m
a
r
g
o
m
y
k
e
h
T
.
a
l
u
t
s
i
f
,
s
u
n
o
t
d
e
s
a
e
r
c
e
d
d
n
a
y
t
i
l
i
t
o
fm
no
o
i
t
i
b
i
h
.
g
i
F
.(
a
i
g
l
a
i
d
r
a
tc
l
e
sf
t
n
e
i
t
a
ep
h
when t
)
.
2
e
nr
o
i
t
i
b
i
h
n
si
i
h
, I used t
e
r
o
f
e
r
e
h
T
i
c
o
n
l
a
r
e
c
s
i
fv
ro
o
t
a
c
i
d
n
s an i
xa
e
l
f
:
.
s
l
a
m
i
n
na
xi
e
l
f
e
r
Material and methods : Cats and
. The methods were
d
e
s
s were u
t
i
b
b
a
r
d above.
e
t
a
t
ss
l the same a
l
a
d
e
t
c
e
j
n
,i
H
C
A
)
n
i
r
e
s
e
fVAG (
to
c
. E任e
.2
・
g
i
F
0
d5
e
g
,a
n
a
fam
ao
l
u
t
a！五s
c
r
ff
Io
J
a
ew
h
ot
t
n
i
5
1
t
n
i
o
p
a
t
a
m
u
e
l
i
e
h
ft
yo
t
i
l
i
t
o
em
h
nt
,o
e
l
a
m
d
e
n
i
a
l
p
m
o
c
s
a
h
e
H
.
a
l
u
t
s
i
f
e
h
t
o
t
l
a
m
i
x
o
r
cmp
.
s
e
t
u
n
i
dJO m
e
t
s
a
,l
n
i
a
p
l
a
n
i
m
o
d
b
fa
o
STUDIESONTHEVISCEROGENICREFLEXES
4
1
Results:
(
1
) when 0.05-0.lcc of ACH (O.lgm./20cc) was
dropped on the wall o
f the ileum, appendix o
rc
o
l
o
n
,
the tonus o
fthestomachandtheduodenumdecreased
and t
h
e
i
r motility was i
n
h
i
b
i
t
e
d
. The same phenomena were demonstrated i
n other d
i
s
t
a
n
t parts o
f the
.
)
alimentary c
a
n
a
l
:(
F
i
g
.3
(
2
) Thephenomenao
fthei
n
h
i
b
i
t
o
r
yr
e
f
l
e
xfollow. Adreing various denervations are shown i
ntable4
nalectomyd
i
dnot have much i
n
f
l
u
e
n
c
e on t
h
i
sr
e
f
l
e
x
.
Discussicn;
Ther
e
s
u
l
t
so
fmyexperimentsprovedthatadequate
stimulation o
f the alimentarycanal causedthei
n
h
i
b
i
r
e
n
timpulses F
i
g
.3
. Them
o
t
i
l
i
t
yo
fc
a
r
d
i
a
,
toryr
e
f
l
e
xwithabdominalp
a
i
n
. Thea旺e
from the ileum are conducted through sympathetic p
y
l
o
r
u
sa
n
dd
u
o
d
e
n
u
mo
f ac
a
t
1 1
2
.
l
K
gF
)a
f
t
e
r
i
n
j
e
c
t
i
o
no
fACH
nerves → s
_
p
l
a
n
c
h
n
i
c nerves → dorsal roots t
os
p
i
n
a
l C川 2
0 0.05c仁 i~ t
h
ei
l
e
u
m
c
o
r
d
, and through vagal n
e
r
v
e
s
,t
o
o
.
N
o
t
et
h
ei
n
h
i
b
i
t
o
no
fm
o
t
i
l
i
t
yo
f
Since i
n myexperimentsmotilityo
fthealimentary e
a
c
ht
r
a
c
t
.
canal was recorded a
t a distant area from the stimulated p
o
i
n
t
, wecan exclude
T
a
b
l
e4
.I
n
t
e
s
t
i
n
a
lI
n
h
i
b
i
t
o
r
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e
f
l
e
xf
o
J
l
o
w
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gV
i
s
c
e
r
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lS
t
i
m
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l
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t
i
o
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f
t
e
rD
e
n
e
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v
a
t
i
o
n
.
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e
n
e
r
v
a
t
i
o
n
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e
r
v
ei
n
t
a
c
t
M
o
f
i
r
r
t
:
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S
t
i
m
u
l
a
t
.S
i
t
e
S
m
a
J
Ii
n
t
e
s
t
i
n
e
L
a
r
g
ei
n
t
e
s
t
i
n
e
S
t
o
m
a
c
h
At~n?ix
S
p
l
a
n
c
h
n
e
c
t
o
m
y
S
p
l
a
n
c
h
n
e
c
t
o
m
y
a
d
r
e
r
i
e
c
t
o
m
y
E
x
s
t
i
r
p
a
t
i
a
no
fg
a
n
g
l
i
o
ns
o
l
a
r
e
S
p
l
a
n
c
h
n
e
c
t
o
m
y
l
u
m
b
a
rs
y
m
p
a
t
h
e
c
t
o
m
y
S
p
l
a
n
c
h
n
e
c
t
o
m
y
v
a
g
o
t
o
m
y
Vagotomy
P
o
s
t
e
r
i
o
rr
h
i
z
o
t
o
m
yT
h
4
・
・
・
T
h
l
2
L
3
Th3・ T
r
a
n
s
e
c
t
i
o
no
fu
p
p
e
rt
h
o
r
a
c
i
cs
p
i
n
a
lc
o
r
d
T
r
a
n
s
e
c
t
i
o
no
fu
p
p
e
rt
h
o
r
a
c
i
cs
p
i
n
a
lc
o
r
da
n
d
v
a
g
o
t
o
m
y
T
r
a
n
s
e
c
t
i
o
no
fTh1
2
R
e
m
o
v
a
lo
fs
p
i
n
a
lc
o
r
d(
T
h5，ー L1
)
S
u
b
a
r
a
c
h
n
o
i
da
l
c
o
h
o
li
n
j
e
c
t
i
o
n
A
i
n
t
r
a
m
u
s
c
u
l
a
r
S
m
a
J
Ii
n
t
e
s
t
i
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e
C
o
l
o
n
I
l
e
u
m
I
l
e
u
m
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l
e
u
m
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l
e
u
m
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l
e
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m
C
o
l
o
n
I
l
e
u
m
I
l
e
u
m
I
l
e
u
m
十一÷十一÷十一÷
1
2l
3
24
4l
632 7 l
3
2
l
3
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ll
2 l2
II
l
3l
l3
4
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円
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雨 空j
¥
2
3巻 消 1号
42
m
y
e
n
t
e
r
i
cr
e
f
l
e
x.
.
+
. SUPPLEMENTARY STUDY ON THE VOMITING.
Nausea andvomiting a
r
ed
i
g
e
s
t
i
v
e symptoms and c
o
n
s
i
d
e
r
e
da
s a.
n
o
c
i
r
e
f
l
.
e
x
a
g
a
i
n
s
tn
o
c
i
s
t
i
m
u
l
i
. My s
t
u
d
y onvomitingwasr
e
s
t
r
i
c
t
e
dt
ot
h
er
e
a
c
t
i
o
ncaused
・
b
ys
t
i
m
u
l
a
t
i
n
gan abdominalv
i
s
c
u
s and t
ot
h
e a妊
巴r
e
n
tn
e
r
v
e
s conducting e
m
e
t
i
c
i
m
p
u
l
s
e
s
. Iu
s
e
dt
h
e ACH-method a
sac
h
e
m
i
c
a
ls
t
i
m
u
l
u
st
ov
o
m
i
t
i
n
g
, and f
a
r
a
d
i
z
a
t
i
o
na
sa c
o
n
t
r
a
s
t method.
A. Experiments on a d
e
c
e
r
e
b
r
a
t
ec
a
t
.
The abovementioned s
t
i
m
u
l
i werea
p
p
l
i
e
dt
ot
h
ea
l
i
m
e
n
t
a
r
yc
a
n
a
lo
fac
a
t
d
e
c
e
r
e
b
r
a
t
e
dbySHERRINGTON’
smethod. When the ACH-methodwasused, cont.
r
a
s
t experimentswere perform~d e
v
e
r
yt
i
m
e
,s
u
c
ha
sf
a
r
a
d
i
z
a
t
i
o
no
r puHing up
t
h
em
e
s
e
n
t
e
r
y
. When0
.
5
c
co
f ACH (0.lgm/
4
c
c
)was i
n
j
e
c
t
e
di
n
t
ot
h
ei
n
t
e
s
t
i
n
a
l
w
a
l
la
f
t
e
r manipulation o
rf
a
r
d
i
z
a
t
i
o
no
ft
h
em
e
s
e
n
t
e
r
y
, vomiting was i
n
d
u
c
e
d
.
F
a
r
a
d
i
z
a
t
i
o
no
ft
h
em
e
s
e
n
t
e
r
y
,b
i
l
i
a
r
yt
r
a
c
t
so
rs
p
l
e
n
i
c hilum a
f
t
e
r subcutaneous
i
n
j
e
c
t
i
o
no
f0.05% vagostigmin o
r ACH (
O
,lgm./4
c
c)
,o
ra
f
t
e
rd
i
s
t
e
n
s
i
o
no
ft
h
e
stomachwith w
a
t
e
r
,c
a
u
s
e
d vomiting u
s
u
a
l
l
y with l
a
t
e
n
t time o
f1
3m
i
n
u
t
e
s
.
But a
f
t
e
rf
a
r
a
d
i
z
a
t
i
o
no
ft
h
ep
a
r
i
e
t
a
lp
e
r
i
t
o
n
e
u
m
,t
h
e diaphragmatic p
e
r
i
t
o
neum o
ro
t
h
e
rs
o
m
a
t
i
cn
e
r
v
e
s
, vomiting d
i
dn
o
to
c
c
u
r
.
T
h
e
r
e
f
o
r
e
, vomiting shouldbec
o
s
i
d
e
r
e
da
sav
i
s
c
e
r
o
g
e
n
i
co
r vagus symptom,
but n
o
tap
e
r
i
t
o
n
e
a
lo
rs
o
m
a
t
i
c symptom.
2
)A
f
t
e
rs
e
c
t
i
o
n oft
h
ev
a
g
i
, vomiting d
i
dn
o
to
c
c
u
rf
o
l
l
o
w
i
n
gf
a
r
a
d
i
z
a
t
i
o
n
.
However, about30minutes a
f
t
e
r subcutaneous i
n
j
e
c
t
i
o
no
f vagostigmin o
r0
.
2
c
c
o
f ACHs
o
l
u
t
i
o
n (O.lgm/
4
c
c
)t
h
ed
e
c
e
r
e
b
r
a
t
eo
rvagotomized c
a
t vomited within
a minutea
f
t
e
re
l
e
c
t
r
i
cs
t
i
m
u
l
a
t
i
o
no
ft
h
em
e
s
e
n
t
e
r
y
.
Subcutaneous i
n
j
e
c
t
i
o
no
ft
h
e some amount o
f vagostigmin o
r ACH s
o
l
u
t
i
o
n
a
l
o
n
ec
o
u
l
dn
o
tc
a
u
s
ev
o
m
i
t
i
n
g
. Theser
e
s
u
l
t
si
n
d
i
c
a
t
et
h
a
tt
h
ea
c
t
i
o
no
f ACH
o
ro
f vagostigmin ont
h
ea
f
f
e
r
e
n
tv
a
g
a
ln
e
r
v
ee
n
d
i
n
g
sf
a
c
i
l
i
t
a
t
evomitingandt
h
a
t
t
h
esympathetictrunk i
sa
l
s
oa p
a
t
ho
ft
h
ee
m
e
t
i
ci
m
p
u
l
s
e
s
.
3
) Denervationexperimentson c
a
t
s
.
a
. Vagotoniy ands
p
l
a
n
c
h
n
e
c
t
o
m
y
.
b
. Phrenicotomy and t
r
a
n
s
e
c
t
i
o
no
ft
h巴 s
p
i
n
a
lc
o
r
da
tt
h
el
e
v
e
lo
ft
h
e2
n
d
,
3
r
d and 5
t
ht
h
o
r
a
c
i
cv
e
r
t
e
b
r
a
e
.
c
. Vagotomy and p
h
r
e
n
i
c
o
t
o
m
y
.
d
. Vagotomy, phrenicotomyand splanchnectomy.
e
. Vagotomy, phrenicotomy and e
x
t
i
r
p
a
t
i
o
no
ft
h
eg
a
n
g
l
i
o
ns
o
l
a
r
e
.
I
n noneo
ft
h
e
s
e experiments vomiting c
o
u
l
d be induced by any method.
I
nt
h
ec
a
s
e
si
n which t
h
es
p
i
n
a
lc
o
r
dwasremovedbelowt
h
el
e
v
e
lo
ft
h
e2
n
d
,
3
r
do
r
5
t
ht
h
o
r
a
c
i
cv
e
r
t
e
b
r
a
e
, vomiting c
o
u
l
d be induced o
n
l
y by e
l
e
c
t
r
i
c
a
ls
t
i
m
u
l
a
t
i
o
no
ft
h
eg
a
s
t
r
i
cv
a
g
u
s
. T
h
e
r
e
f
o
r
e
,v
a
g
a
l and sympatheticn
e
r
v
e
s conductt
h
e
r
e
n
te
m
e
t
i
ci
m
p
u
l
s
e
s
,b
u
tv
a
g
ip
l
a
yt
h
e primary r
o
l
e
.
a妊e
B
. Experiments on v
o
m
i
t
i
n
gc
a
u
s
e
d by s
t
i
m
u
l
a
t
i
o
no
ft
h
eduodenum o
fu
n
a
n
e
s
t
h
e
t
i
z
e
dc
at
s
.
STUDIESONTHEVISCEROGENICREFLEXES
4
3
巴p
o
r
t
e
dt
h
a
t continuous d
i
s
t
e
n
s
i
o
no
fi
n
t
e
s
t
i
n
a
l五
s
t
u
l
a
ei
n
HERRIN and MEEKr
dogs caused anorexia and vomiting. SHRAGERand IVYfoundt
h
a
t the d
i
s
t
e
n
s
i
o
n
,vomiting and d
i
s
t
r巴s
s
.
o
f the g
a
l
lb
l
a
d
d
e
r and b
i
l
i
a
r
y duct i
nd
o
g
s causednaus巴a
With unanesthetized c
a
t
s
, It
r
i
e
d an experiment t
oc
a
u
s
e
.vomitingb
y
_s
t
i
m
u
l
a
t
i
o
n
o
ft
h
e duodenalmucous membrane. F
i
r
s
t Imade a duodenal f
i
s
t
u
l
ai
nac
a
tand
then i
n
j
e
c
t
e
d slowly o
rr
a
p
i
d
l
yN/5-10HCl3
5
I
O
c
c
,ACH(O.lgm/20cc)3-lOcc o
r
water i
n
t
ot
h
e duodenum through a c
a
t
h
e
t
e
ri
n
s
e
r
t
e
di
nt
h
e duodenal 五
s
t
u
l
a
.
Duringt
h
eexperiment,t
h
ec
a
twasq
u
i
e
t
. Withins
e
v
e
r
a
lminutest
h
ec
a
tvomited.
)
.
(
F
i
g
.4
ず
.
，
必後与
F
i
g
・4
.V
o
m
i
t
i
n
ga
f
t
e
ri
n
j
e
c
t
i
o
no
fACH(0.1/20)3
c
ci
n
t
ot
h
ed
u
o
d
e
n
u
mt
h
r
o
u
g
hac
a
t
h
e
t
e
ri
n
t
u
l
a
.
t
h
ed
u
o
d
e
n
a
l五s
I
n
j
e
c
t
i
o
no
f HCl o
r ACH i
n
t
ot
h
e duodenum causcd i
n
h
i
b
i
t
i
o
no
fm
o
t
i
l
i
t
yo
f
t
h
e proximal p
a
r
to
ft
h
e duodenum and o
fthestomacha
si
n五g
.5
. When given
bymouth, t
h
e
s
e chemicals d
i
d not indu~e vomiting.
1
.
4
F
i
g
・
.5
. T
h
em
o
t
i
l
i
t
yo
fs
t
o
m
a
c
ho
fc
a
t(
K
g
,F
)b
yv
o
m
i
t
i
n
ga
f
t
e
ri
n
j
e
c
t
;
o
no
fN
/
5HCl
t
u
l
a
.
l
O
c
ci
n
t
ot
h
ed
u
o
d
e
n
u
mt
h
r
o
u
g
h五s
誕 v
o
m
i
t
i
n
g
T
h
em
o
t
i
l
i
t
yo
fp
r
o
x
i
m
a
ld
u
o
d
e
n
u
ma
f
t
e
r
i
n
j
e
c
t
i
o
no
fN/
5 HCl 4
c
ci
n
t
ot
h
ed
i
s
t
a
l
d
u
o
d
e
n
u
m
.
V口町i
t
i
n
g
器
After vagotomy, t
h
ec
a
td
i
d not v
o
m
i
t
, but a
f
t
e
r subcutaneous i
n
j
e
c
t
i
o
no
f
vagostigmin-ACH, i
t vomited a
f
t
e
rt
h
e same s
t
i
m
u
l
u
s
. B
i
l
a
t
e
r
a
l abdominal sympathectomy and splanchnectomy i
n
h
i
b
i
t
e
d vomitipg c
o
m
p
l
e
t
e
l
y
. Inflammation o
f
t
h
e peritoneum f
a
c
i
l
i
t
a
t
e
d vomiting.
After phrenicotomy, t
h
ec
a
t vomited by t
h
e same s
t
i
m
u
l
u
s
, butnota
f
t
e
rt
r
a
n
-
日 本 外 科 宝 曲 第2
3
巻 第 1号
4
4
section of the spinal cord (T4,TS,T6). From these experiments i
ti
s clear that
the a妊erent nervous pathways of vomiting are vagal and sympathetic nerves.
C
. Vomiting and adrenergic and cholinergic changes in blood.
Onemaywonderwhether thevomitingcaused by ACH
in m yexperiments i
sneurogenic orhumoral,becauseACH
may induce vomiting by stimulation of the medullary
vomiting center through the general circulation.
injected sudcutaneously can cause vomiting.
ACH
Therefore
Iinvestigatedadrenergic andcholinergicchanges inblood
’
smethodwhen the
by MUSSER-GRIM
duodenm was stimulated by ACH,
faradizationor puttingHCLsolution
F
i
g
.6
. Upper:
E
f
f
e
c
to
f
b
l
o
o
dl
e
eo
ft
h
ec
a
ta
f
t
e
r
i
n
j
r
c
t
i
o
no
f ACHi
nt
h
e
w
a
J
J
.o
fthi
k
m
,
0
1
・ t
h
e
t
i
l
i
t
yo
fi
s
o
l
a
t
e
dd
e
e
d
ぞr
:
a
l
l
o
o
po
fr
a
b
b
i
t
.
(
N
o
.1
1on
T
a
b
l
e3
)(
T
h
i
si
sM
u
s
s
e
r
smcthodm)
Grimm’
Lower:B
e
f
o
r
ei
n
j
e
c
t
i
o
n
.
mto 1
t
.
Before stimulat
ion, the blood of
decerebrate cats showed sometimes
adrenergic and sometimescholinergic
r巴actions. For about 5minutes after
i
:
n
u
l
a
t
i
o
n
,p
a
r
t
i
c
u
l
a
r
y
Tabl 5
. C
h
a
n
g
e
so
ft
h
eHumorals
u
b
s
t
a
n
c
e
si
nB
l
o
o
df
o
l
l
o
w
i
n
gV
i
s
c
e
r
a
lらt
a
tv
o
m
t
f
r
n
g
.
C
a
s
e
s
I
B
e
f
o
r
eI
HumoralS
u
b
s加の−i
;
!l
l嗣
A
f
t
e
ra
d
m
i
n
i
s
t
r
a
t
i
o
no
fAC
H
s
o
l
u
t
i
o
n
(
1
)l
.
7
K
gc
a
t
N
I
A
d
r
. !
n2m
i
n
.a
f
t
IC
h
o
l
.i
n1
5m
i
n
.
(
2
)3Kg c
a
t
(
3
)l
.
2
K
gc
a
t
N
N
N
IAdr. i
口 5mi
口
.a
f
t
e
rn
a
u
s
e
a(ACHi
n
j
e
c
t
e
di
nduod
士n
a
l
w
a
l
l
.
)
IN. soona
f
t
e
rv
o
m
i
t
i
n
g(
b
yf
a
r
a
d
i
z
a
t
i
o
n
)
.
IAdr. i
n1m
i
n
.a
f
t
e
rv
o
m
i
t
i
n
g(ACHO
.
i
/
3c
cs
o
l
u
t
i
o
n0
.
1c
c川氏t
e
di
nt
h
e
(
4
)2
.
0
K
gc
a
t
(
5
)5Kg dog
a
t
(
6
) l.6~g c
(
7
)1
.
4
K
gc
a
t
(
8
)1
.
7
K
gc
a
t
(
9
)3
.
0
K
gc
a
t
(
1
0
)2
.
3
K
gc
a
t
'
w
a
l
lo
fi
l
e
u
m
.
A
d
r
. i
n2m
i
n
.a
f
t
e
ri
n
j
e
c
t
i
o
no
fA
C
H
s
o
l
u
t
i
o
ni
ni
l
e
u
m
w
a
l
l
.
A
d
r
. i
n4
0m
i
n
.
N
N
. i
n6
0m
i
n
. (Nov
o
m
i
t
i
n
g
)
C
h
o
l
.
i
n
5
m
i
n
.
a
f
t
e
r
i
n
j
e
c
t
i
o
n
o
fACHi
nd
u
o
d
e
n
u
m
.
N
N
. i
n4
0m
i
n
.
、
C
h
o
l
. A
d
r
. i
n2m
i
n
.a
f
t
e
rv
o
m
i
t
i
n
g
.
N
A
d
r
. a
f
t
e
ri
n
j
e
c
t
i
o
no
fACH (
0
.
1
/
2
0
c
c
)I
O
c
ci
nd
u
o
d
e
n
u
m
.Nov
o
m
i
t
i
n
g
.
A
d
r
.
i
n
1
.
5
m
i
n
.
a
f
t
e
r
v
o
m
i
t
i
n
g
(
b
y
i
n
j
e
c
t
i
o
n
o
f
A
C
H
s
o
l
u
t
i
o
a
(
0
.
1
/
5
c
c
)
0
.
1
A
d
r
.
a
l
l
.
c
ci
n
t
od
u
o
d
e
n
a
lw
s
l
i
g
h
t A
d
r
. i
n1
5m
i
n
.
C
h
o
l
. N
. s
o
o
na
f
t
e
ri
n
j
e
c
t
i
o
no
fA
:
H
s
o
l
u
t
i
o
nt
od
u
o
d
e
n
a
l
w
a
l
l
.
s
l
i
g
h
t A
d
r
.3
0m
i
n
.a
f
t
e
rv
o
m
i
t
i
n
g
.
司
(
1
1
)2
.
B
K
gc
a
t
C
h
o
l
.
(
1
2
)2
.
5
K
gc
a
t
N
同 l.BKgc
a
t
(
1
1
)2
.
6
K
gc
a
t
A
d
r
. i
n3m
i
n
.a
f
t
e
ri
n
j
e
c
t
i
o
no
fACH-solution(
O
.
l
/
5
c
c
)0
.
l
c
ct
ot
h
ed
u
o
d
e
n
a
lw
a
l
l
.
N
.
N
.
i
n1
5m
i
n
.a
f
t
e
ri
n
j
e
c
t
i
o
no
fACHi
nu
r
i
n
a
r
yb
l
a
d
d
e
r
.Nov
o
m
i
t
i
n
g
.
i
n5m
i
n
.a
f
t
e
ri
n
j
e
c
t
i
o
no
fACH-solutinn(
0
.
1
/
5c
c
)0
.
2c
ci
nd
u
o
d
e
n
a
l
A
d
r
.
w
a
l
l
.
A
<
l
r
. i
n2m
i
n
.a
f
t
e
rv
o
m
i
t
i
n
g
.
C
h
o
l
. A
d
r
. markedlyi
n1
8s
e
c
o
n
d
sb
e
f
o
r
ev
o
m
i
t
i
n
g
.
s
l
i
g
h
t A
d
r
. s
l
i
g
h
t
l
y
.v
o
m
i
t
i
n
gs
e
v
e
r
a
lm
i
n
u
t
e
sl
a
t
e
r
.
A
d
r
.・
・
・
・
・
・
B
l
o
o
ds
h
o
w
e
da
d
r
e
n
e
r
g
i
c
.
・
・C
h
o
l
i
n
e
r
g
i
c
.
C
h
o
l
.
・・
N
.
・一
.
.
.Notchanged.
STUDIESONTHEVISCEROGENICREFLEXES
45
s
t
i
m
u
l
a
t
i
o
no
f the duodenum by ACH, the blood tended t
o be a
d
r
e
n
e
r
g
i
cand30
minutes a
f
t
e
rs
t
i
m
u
l
a
t
i
o
n completely c
h
o
l
i
n
e
r
g
i
c
. (Table5
.F
i
g
.6
.
)
I
f vomiting i
s due t
o ACH i
n the b
l
o
o
d
, t
h
e b
l
o
o
d
,s
o
u
l
d be c
h
o
l
i
n
e
r
g
i
c
immediatelya
f
t
e
ra
d
m
i
n
i
s
t
τ
a
t
i
o
no
fACH. T
h
e
r
e
f
o
r
e
,vomiting i
n myexperiments
r
au
s
t be a r
e
f
l
e
x phenomenon.
5
. VASOMOTOR RESPONSE TO ACH METHOD.
h
e blood
Ac
a
t was a
n
e
s
t
h
e
t
i
z
e
d with 20話 urethan 3-5cc and I measured t
p
r
e
s
s
u
r
e through a c
a
r
o
t
i
da
r
t
e
r
y
.
璽
，
．
. W
henVAG-ACHI(
F
i
g
.7
0
.
1
/
5
)0
.
C
5
c
cw
a
sd
r
o
p
p
e
do
n
t
h
ei
l
e
u
mo
fc
a
t
,b
l
o
o
dp
r
e
s
s
u
r
e
i
n
c
r
e
a
s
e
d
.
F
i
g
.9
. T
e
m
p
o
r
a
r
yi
n
c
r
e
a
s
eo
fb
l
o
o
dp
r
e
s
s
u
r
e
,
f
o
l
l
o
w
e
db
yd
e
c
r
e
a
s
e
,
. C
h
a
n
g
eo
fb
l
o
o
dp
r
e
s
s
u
r
ew
h
e
n w
h
e
nVAG-ACH(
0
.
1
/
F
i
g
・
.8
・
（0
.
1
/
5
0
)0
.
0
5
c
c(
l
e
f
t
s
i
d
e
)a
n
d 5) 0
.
0
5
c
cw
a
si
n
j
e
c
t
e
d
VAG-ACH
50%N
a
I0
.
0
5
c
c(
r
i
g
h
ts
i
d
e
)w
e
r
ei
n
j
e
c
t
e
d i
nt
h
ew
a
l
lo
ft
h
ei
n
i
nt
h
es
u
p
e
r
i
o
rm
e
s
e
n
t
e
r
i
ca
r
t
e
r
y
.
t
e
s
t
i
n
eo
fac
a
t
.
(
1
) When vagostigmin-ACH (
O.lgm/5cc) 0
.
0
5
c
c
si
n
t
e
s
t
i
n
e
,t
h
ebloodp
r
e
s
s
u
r
e
was dropped on t
h
ec
a
t’
i
n
c
r
e
a
s
e
d immediately and then grandualTy d
e
c
r
e
a
s
e
d
.
(
F
i
g
.7
.
)
(
2
) When ACH O.lgm/lOOcc 0
.
0
5
c
co
r 50% Nal
s
o
l
u
t
i
o
n was i
n
j
e
c
t
e
di
n
t
o the m
e
s
e
n
t
e
r
i
c
.a
r
t
e
r
y
,t
h
e
blood p
r
e
s
s
u
r
ei
n
c
r
e
a
s
e
d mark巴d
l
ywith c
o
n
t
r
a
c
t
i
o
no
f
t
h
er
e
g
i
o
n
a
li
n
t
e
s
t
i
n
e
. andthend
e
c
r
e
a
s
e
d
. (
F
i
g
.8
.
)
(
3
) When ACH wasi
n
j
e
c
t
e
di
n
t
ot
h
ewallo
ft
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i
n
t
e
s
t
i
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e
.
t
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eblood p
r
e
s
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r
ei
n
c
r
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a
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e
m
p
o
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r
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y
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r
a
p
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d
l
yd
e
c
r
e
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d
.(
F
i
g
.9
.
)
(
4} When ACH was i
n
j
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c
t
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di
n
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ot
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e blood p
r
e
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r
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l
l immediatelydownt
o 50lOOmg Hg. I
t was the same a
s intramuscular i
n
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c
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f ACH (
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g
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a
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l
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(
5
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d the blood p
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n
0
. M
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.
日本外科宝山内第23
巻 第 1号
46
g
e
n
e
r
a
l
.
(
6) Afters
e
c
t
i
o
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ft
h
esympatheticandsplanchnicn
e
r
v
e
s
,o
ra
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t
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rsplanchnic
a
n
e
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t
h
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i
a
,t
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sv
a
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o
p
r
e
s
s
o
rr
e
a
c
t
i
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n was a
b
o
l
i
s
h
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d
.
Thisr
e
a
c
t
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nwasa
l
s
oa
b
o
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i
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h
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dbyTEAB. Followingt
r
a
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s
e
c
t
i
o
no
fthes
p
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n
a
l
cord (
T
2
, T3, T4, T5, T6), t
h
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c
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i
m
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i
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d
. S
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c
t
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o
no
f the v
a
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i
had no i
n
f
l
u
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n
c
e on t
h
i
sr
e
a
c
t
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o
n
.
6
.COMPLEMENTALSTUDY O N TETRAETHYL AMMONIUM BROMIDE.
ACHSONand MOE found t
h
a
t TEAB blocked the conduction o
f impulses i
n
the ganglia o
ft
h
e autonomic n
e
r
v
e
s
. But i
n my s
t
u
d
i
e
so
f various r
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f
l
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x
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s
,t
h
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r
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n
timpulses were not blocked by TEAB.
a任e
TEAB.i
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l6
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to
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r
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g abdominal pain i
n
M
o
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yc
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n
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n
t
s
. T
h
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f
o
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e
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r
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d 一一一一一一一 D
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1
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0 I5 f 10 2
0
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t
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o i
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c
l
i
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i
c
a
lc
a
s
e
s
.
A 57 year o
l
d male was
N
u
m
b
e
rs
h
o
w
sc
a
s
e
s
.
operated f
o
r carcinoma o
ft
h
e rectum. 2days a
f
t
e
r the operation o
f making a
colostomy,t
h
em
o
t
i
l
i
t
yo
ft
h
e sigmoid was not r
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s
t
o
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巴d
. Intravenousi
n
j
e
c
t
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.
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c
chad an e
f
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e
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emotilty
After2 weeks, m
o
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a
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り仇 −
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m
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c
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O
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f TEAB l
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f
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t
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f
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o
t
r
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and h
t became hypera
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the i
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d
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7
x
e
l
f
e
f visceromotor r
The theory o
d by MACKENZIE, whose
e
b
i
r
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e
was d
n was based on$HERRINGo
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p
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e
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t abdominal
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h
s experiments, t
TON’
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e hindlimb muscles
h
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eromotor r
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c
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I
.
NALINE(1/1000) O
48
日 窓 外 科 室 曲 第3
巻 第 1号
a
sw
e
l
la
st
h
eabdominalm
u
s
c
l
e
sa
c
t
e
da
se
宜e
c
t
o
r
s
.
Method:
D
e
c
e
r
e
b
r
a
t
ec
a
t
swere employed($HERRINGTON’
smethod). Thecontractiono
f
t
h
eabdominalr
e
c
t
u
smusclewasshownbydiagrambyMILLER
’
smethod‘ Iused
v
a
r
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o
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ss
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m
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l
if
o
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o
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n(
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a
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n and p
u
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n
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s
e
n
t
e
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ywith t
h
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r
s
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e
s
u
l
t
s:
1
) F
a
r
a
d
i
z
a
t
i
o
no
ft
h
eabdom ~ nal r
e
c
t
u
sm
u
s
c
l
e
s
,whichwasf
o
l
l
o
w
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dbyc
l
o
n
i
c
c
o
n
t
r
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c
t
i
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r
a
d
u
a
l
l
yd
e
c
l
i
n
e
d
.
2
) S
t
r
e
t
c
h
i
n
go
ft
h
ei
n
t
e
s
t
i
n
a
lt
r
a
c
t and t
r
a
c
t
i
o
no
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e
s
e
n
t
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r
yc
a
u
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d
r
e
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l
e
xc
o
n
t
r
a
c
t
i
o
no
ft
h
eabdominalm
u
s
c
l
e
s
. S
t
r
o
n
g
e
rr
e
丑exr
e
s
p
o
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ewaic
a
u
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e
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byf
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r
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o
no
rm
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h
a
n
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a
ls
t
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t
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o
no
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i
l
i
a
r
yt
r
a
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t
so
rhilumo
ft
h
es
p
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e
e
n
.
3
) I
n
j
e
c
t
i
o
no
f vagostigmin-ACJi (
0
.
1
gm/Sec)i
nt
h
ei
n
t
e
s
t
i
n
a
lw
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l
lc
au
s
e
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l
o
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c
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o
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r
a
c
t
i
o
no
ft
h
eabdominalm
u
s
c
l
e
s
,which
g
r
a
d
u
a
l
l
yr
o
s
et
ot
h
emaximumandd
e
c
l
i
n
e
d
s
l
o
w
l
y
.
Subcutaneouso
ri
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r
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m
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e
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Tl3-L3.
Colon :
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l
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xc
o
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t
r
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t
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ft
h
e abdominalmuscles o
c
c
u
r
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e
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t
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o
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f
t
h
es
p
l
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n
c
h
n
i
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e
r
v
e
s
. But i
td
i
dn
o
to
c
c
u
ra
f
t
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r splanchnectomy and lumbar
sympathectomy. A
f
t
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x
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.
日 木 外 科 宝 耐 第2
3
巻 第 1号
5
0
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, but s
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.
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:
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a
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t
s aboves
t
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da
r
esupported bymyexperimentso
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t
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r
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rr
h
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tomy:
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i
l
i
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r
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r
a
c
t
s;T5-Tl3:
Appendixand c
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n ;Tl2-L6.
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t
sa
r
e somewhat d
i
f
f
e
r
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n
t from the r
e
s
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l
t
s above mentioned. The
u
p
p
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e
d
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h
a
tr
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c
t
u
s muscles were
r
e
a
s
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, Is
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r
v
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d by i
n
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c
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f the stomach, duodenu and jejunum, but not by
、
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h
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a
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,
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h
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p
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c
h
n
i
cn
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r
v
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s
, 2nd t
o6
t
h lumbar sympathetics and ganglion
s
o
l
a
r
e were r
e
s
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c
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M
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: found t
h
a
t a
f
t
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r u
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p
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g
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f
t
e
r
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r
a
l sympathectomy and t
r
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e
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llumbar sympathectomy, t
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e
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t
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e sames
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d by s
t
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o
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s
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s
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e
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i
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ec
o
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r
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e
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e
f
o
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e
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t
e
r
a
ls
ympathectomy and splanchnectomy, cont
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o
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f each
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e
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t
u
smusclewas a
b
o
l
i
s
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e
d
.(
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i
g
.1
6
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i
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r
e blocked u
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s
, we can assumet
h
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r
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h
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h
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h
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c
s do n
o
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o
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f
t
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o
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s
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x movem巴n
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ft
h
e abdominal m
u
s
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s was demonstrated by s
t
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l
a
t
i
o
no
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td
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o
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e stomach, s
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n and b
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r
yt
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v
e
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n agreement with h
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2
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f
t
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ri
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e
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c
c
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m
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e
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o
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c
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r
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y
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n
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e
n
c
e
d
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1
3
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t
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n
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o
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rt
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o
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m
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l
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d with a
l
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lshowed d
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oL
3
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s
p
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la
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e
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r
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e
d
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8
. SOME CLINICAL OBSERVATION. (
1
)
Frommy e
x
p
e
r
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m
e
n
t
s
, Ic
o
n
s
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rt
h
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o
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r
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a
t
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t
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i
s
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e
r
a
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e
n
s
a
t
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o
n by Ray and N
e
i
la
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t
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ru
n
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l
a
t
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:a
lsympathectomyi
sn
o
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l
yaphenomenon
i
nv
i
s
c
e
r
a
, but a
l
s
oa phenomenon o
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r
f
a
c
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h
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o
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y
.
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u
d
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e
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h
ea
b
i
l
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t
yt
ol
o
c
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l
i
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et
h
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o
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n
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s(
l
o
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a
ls
i
g
n
)i
nt
h
em
i
d
l
i
n
eo
ft
h
e
abdominal w
a
l
li
n human b
e
i
n
g
sa
f
t
e
r laparotomy w"th p
a
r
a
r
e
c
t
u
si
n
c
i
s
i
o
n
.
Touching v
a
r
i
o
u
sp
o
i
n
t
s on t
h
e abdominal w
a
l
l
, I asked p
a
t
i
P
,
n
t
s
, who had
an i
n
c
i
s
i
o
non ones
i
d
e
,t
ot
e
l
l which p
o
i
n
t
s were on t
h
em
i
d
l
i
n
e
. Nono
p
e
r
a
t
e
d
p
a
t
i
e
n
t
sf
e
l
tt
h
e middle p
o
i
n
t
so
ft
h
e abdominal w
a
l
la
l
m
o
s
tc
o
r
r
e
c
t
l
ywithd
i旺e
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n
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e
so
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m
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当 第23
巻 第 1号
52
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But most p
a
t
i
e
n
t
swho had had laparotomy by r
i
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a
r
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r
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o
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o
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i
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ot
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e
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twhen Itouched t
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i
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nextreme c
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e
s
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r
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e
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t ont
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. L
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t
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ot
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oi
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o
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r
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o
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e
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r
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e
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r
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t
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g
t
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e wounds
which i
n
f
l
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e
n
c
e
dl
o
c
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l
i
z
a
t
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o
n was 5-20cm.
F
i
g
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7 shows t
h
ep
o
i
n
t
sp
e
r
c
i
e
v
e
da
si
nt
h
em
i
d
l
i
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e by p
a
t
i
e
n
t
swho had
laparotomy with r
i
g
h
tp
a
r
a
r
e
c
t
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si
n
c
i
s
i
o
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s
. Among 24c
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s
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t
i
e
n
t
swho had
l
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t
e
r
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ot
h
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i
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t
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o
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o noni
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o
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i
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r
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r
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o
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h
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e
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ts
i
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e
.
phenomenon. (
F
i
g
.1
7
)
Some s
c
h
o
l
a
r
ss
a
i
dt
h
a
ts
o
c
a
l
l
e
dv
i
s
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e
r
a
l
.p
a
i
nd
i
d not o
c
c
u
ri
nt
h
ev
i
s
c
u
s
i
t
s
e
l
f
,buti
nt
h
eabdominalw
a
l
lbyt
h
er
e
f
l
e
xc
o
n
t
r
a
c
t
i
o
no
ft
h
em
u
s
c
l
e
s
. Soc
o
n
t
r
a
l
a
t
e
t
叫i
s
a
t
i
o
no
fv
i
s
c
e
r
a
ls
e
n
s
a
t
i
o
nmay bec
o
n
s
i
d
e
r
e
da
sa
l
r
e
s
u
l
to
fv
i
s
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e
r
o
s
o
m
a
t
i
c
r
e
f
l
e
x on t
h
eabdominal w
a
l
l
. As s
t
a
t
e
da
b
o
v
e
, unilateralsympathectomy caused
v
i
s
c
e
r
o
m
o
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o
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r
貝
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ot
h
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n
l
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h
ec
o
n
t
r
a
l
a
t
e
r
a
ls
i
d
e
. Theref
o
r
e my experiment seems t
o be i
n accordance with RAY-NEIL
’
sphenomenon.
However v
i
s
c
e
r
a
lp
a
i
ni
s not o
n
l
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e
f
e
r
r
e
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a
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h
e
r
ei
sa
l
s
ot
r
u
ev
i
s
c
e
r
l
p
a
i
n
. So t
h
i
sexperiment i
sn
o
te
n
o
u
S
"
ht
o prove c
o
n
t
:
r
a
l
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t
e
r
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i
s
a
t
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o
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STUDIESONTHEVISCEROGENI
CREFLEXES
5
3
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e
n
s
a
t
i
o
n
. The s
i
g
n
i
f
i
c
a
n
c
eo
fc
o
n
t
r
a
l
a
t
e
r
a
l
i
s
a
t
i
o
nw
i
l
l be w
e
l
lu
n
d
e
r
s
t
o
o
da
sa
d
y
s
f
u
n
c
t
i
o
no
ft
h
ei
n
i
t
i
a
ll
o
c
a
ls
i
g
n
.
9
. SOME CLINICALOBSERVATION. (
2
)
Mooreand o
t
h
e
r
sd
e
s
c
r
i
b
e
dt
h
a
ti
n
j
e
c
t
i
o
no
f some i
r
r
i
t
a
t
i
n
gc
h
e
m
i
c
a
l
si
n
t
o
a
r
t
e
r
i
e
so
fa
n
i
m
a
l
sc
a
u
s
e
dp
a
i
no
fblood v
e
s
s
e
l
s
.
I
n
j
e
c
t
i
o
no
f 50% NaI s
o
l
u
t
i
o
ni
n
t
ot
h
es
u
p
e
r
i
o
rm
e
s
e
n
t
e
r
i
ca
r
t
e
r
yc
a
u
s
e
dc
a
r
d
i
a
l
g
i
ai
n8 c
a
s
e
s
,i
n
j
e
c
t
i
o
no
ft
h
i
s chemical i
n
t
ot
h
ei
l
e
o
c
o
l
i
ca
r
t
e
r
y caused c
a
r
d
i
a
l
g
i
ai
n2c
a
s
e
s
, but i
n
j
e
c
t
i
o
ni
n
t
oe
p
i
p
l
o
i
ca
r
t
e
r
yd
i
dn
o
tc
a
u
s
ep
a
i
ni
n3c
a
s
e
s.
(
F
i
g
.1
8
)
,
,
.
.
F
i
g
. 18. B
A
f
t
e
ri
e
f
o
n
j
r
E
ei
c
t
i
n
o
j
n
e
.
c
t
i
o
no
f50%N
a
ls
o
l
u
t
i
o
n
i
n
t
oab
r
a
n
c
ho
ft
h
es
u
p
e
r
i
o
rm
e
s
e
n
t
e
r
i
ca
r
t
e
r
y
.
S
t
r
e
t
c
h
i
n
go
rs
p
a
s
t
i
cc
o
n
t
r
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c
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i
o
no
ft
h
esmooth muscle h
a
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o
n
s
i
d
e
r
e
da
s
an important mechanism c
a
u
s
i
n
gv
i
s
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e
r
a
lp
a
i
n
. Ii
n
j
e
c
t
e
<
l ACH (O.Igm/lOOcc)
O
.
l
0
.
2
c
ci
n
t
oa brancho
fs
u
p
e
r
i
o
rm
e
s
e
n
t
e
r
i
ca
r
t
e
r
yi
n1
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a
s
e
sd
u
r
i
n
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p
a
i
n wasi
n
d
u
c
e
d with spasm o
ft
h
ei
n
t
e
s
t
i
n
e
.
When p
a
i
n was c
a
u
s
e
d
,t
h弓 i
n
t
e
s
t
i
n
ealways showed s
p
a
s
m
. T
h
e
r
e
f
o
r
e I can
assumet
h叫 50% NaI o
r ACH s
o
l
u
t
i
o
nw
i
l
l work on t
h
e smooth m
u
s
c
l
e
, and. ~
t
h
e
nc
o
n
t
r
a
c
t
i
o
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ft
h
e smoothmusc
l
e
sw
i
l
la
c
tons
e
n
s
o
r
yn
e
r
v
ee
n
d
i
n
g
s
.
H. SETO, A. OTSU, demonstrated
s
e
n
s
o
r
y n
e
r
v
ee
n
d
i
n
g
s i
n v
a
r
i
o
u
s
p
a
r
t
so
ft
h
e alimentar＿~－ _
,
c
a
n
a
l
.
1
0
. SOME CLINICAL
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3
)
I
) The p
a
t
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e
n
t
si
nwhomappend
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c
e
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t
i
m
u
l
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t
e
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3
6
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a
s
e
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t
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9
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s
e
s
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e
l
tp
a
i
ni
nt
h
es
i
t
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c
l
o
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et
ot
h
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i
d
l
i
n
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h
e abdomin
a
ls
u
r
f
a
c
ei
n
n
e
r
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a
t
e
d by t
h
en
e
r
v
e
s
T~－TIO, e
s
p
e
c
i
a
l
l
y T8-T9. (
F
i
g
.1
9
)
F
i
g
.1
9
.
l
r
.
,T
h
es
i
t
eo
ff
e
e
l
i
n
g T
h
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i
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e
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o
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d
o
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i
n
a
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i
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h
e p
a
i
nf
r
o
ma
p
p
e
n
d
i
x
l
i
g
a
t
u
r
eo
f m
e
s
o
a
p
p
e
n
d
i
x
. b
yACHm
e
t
h
o
d
.
I
t
sl
o
c
a
l
i
z
a
t
i
o
ni
sc
l
e
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ra
n
d
i
t
s
:
d
e
g
r
e
ei
ss
t
r
o
n
g
.
巻
日木外科宝前 第23
54
第 1号
f
a and occurence o
i
s
e
h
t
s
e
n
a
l'
a
n
i
p
fs
p between the spread o
i
h
s
n
o
i
t
a
l
e
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g
n
i
t
a
l
u
m
i
t
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y
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e
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SUMARY.
Visceral pain accompanies many r
e
f
l
e
x phenomena, e
s
p
e
c
i
a
l
l
yi
nd
e
c
e
r
e
b
r
a
t
_
e
animals ($HERRINGTON). To study v
i
s
c
e
r
a
ls
e
n
s
a
t
i
o
n
, I employed various r
e包ex
， p
up
i
l
l
o
d
i
l
at
o
rr
e
f
l
e
x
,
c
r
i
t
e
r
i
a
, such a
s changing o
fr
e
s
p
i
r
a
t
i
o
n
, blood p
r
e
s
s
u
rぞ
visceromotor and vomiting r
e
f
l
e
x
.
The r
e
s
u
l
t
s such a
si
n
c
r
e
a
s
eo
f blood p
r
e
s
s
u
r
e
,d
i
l
a
t
a
t
i
o
no
fp
u
p
i
l
s and s
oo
n
,
should be c
o
n
s
i
d
e
r
e
da
s the r
e
s
u
l
t
so
fe
x
c
i
t
a
t
i
o
no
f sympathetic system.
There may be changing o
f humoral substance i
n blood by v
i
s
c
e
r
a
lp
a
i
n
. I
demonstrated i
t by MUSSER-GRIMM’
smethod. The blood tends to become adrenergic soon a
f
t
e
r vomiting o
r administration o
f greatd
o
s
i
so
f ACH. A humoral
巴
百e
c
to
fsomei
n
h
i
b
i
t
o
r
ysubstance cannotbecompletely excluded i
n mystudyo
f
thei
n
t
e
s
t
i
n
a
li
n
h
i
b
i
t
o
r
yr
e
f
l
e
x
. However, s
i
n
c
e adrenalectomy did not reducet
h
e
o
n
s
i
d
e
rthat the neurogenicr
e
f
l
e
xp
l
a
y
sag
r
e
a
t
e
rr
o
l
lthan
degree o
ft
h
i
sr
e
f
l
e
x
,Ic
thehumorale任e
c
t
.
r
e
n
tpathways which are r
e
s
p
o
n
s
i
b
l
efor anorexia andvomitingare i
n
The a妊e
the vagi and only i
n some exceptional c
a
s
e
st
h
e splanchnic n
e
r
v
e
s
.
e
f
l
e
x
The visceromotor r
e
f
l
e
x has the most simple r
e
f
l
e
xa
r
c among t
h
e
s
er
phenomena. The r
e自ex a
r
c involves a
f
f
e
r
e
n
tf
i
b
e
r
s only i
n the splanchnic n
e
r
v
e
s
.
I
nt
h
i
sr
e自e
x
,a
f
f
e
r
e
n
t 自h
e
r
si
n the v
a
g
i
, even i
f they e
x
i
s
t
, play a minor r
o
l
e
.
白木外科宝l
必 第2
3巻 第 1号
5
6
The visceromotor r
e
f
l
e
xo
f decerebrate cats wasu
t
i
l
i
z
e
dtodeterminethed
i
s
t
r
i
b
u
tion o
f a妊erentf
i
b
e
r
so
f the splanchnic nerves t
o the・
spinal roots through which
they enter the spinal c
o
r
d
. Wide segmental overlapping innervation o
fa
f
f
e
r
e
n
t
nerves was established as i
n e任erent nerves. And yet afferent nerve 五
hers from
a viscus may spread widely i
n the sympathetic trunk and enter the spinal cord
at several l
e
v
e
l
s
, from which e任erent nerves run to the rectus muscles o
f both
s
i
d
e
s
.
Experiments of u
n
i
l
a
t
e
r
a
l sympathectomy show that a few a任erentf
i
b
e
r
s may
c
r
o
s
s to the other s
i
d
e
. And there i
s a relationship between the l
a
t
e
r
a
l
i
s
a
t
i
o
no
f
the visceromotor r
e
但exand c
ontralateralisat
ion o
fv
i
s
c
e
r
a
l pain (SMITHWICKe
ta
l
)
a
s well as between these and i
n
i
t
i
a
ll
o
c
a
ls
i
g
r
i (KIMURA).
M y experiments o
f spinal anesthesia and i
n
j
e
c
t
i
o
no
f alcohol into the subarachnoid s
p
a
c
e
, show that the vagi probably do not conduct impulses from the
abdominal v
i
s
c
e
r
a except emetic impulses.
Iam much indebted to Assist. Prof. Ch. KIMURA, M. D
. of our clinic for
h
i
s constant help throughout my study. And t
h
i
s was read by him as a parto
f
h
i
st
h
e
i
:
n
a "Operation o
f Autonomic Nervous System" at the51 :AnnualMeeting
of the Japanese S
u
r
g
i
c
f
:
1
.
l Association. on April I∼3.
1951, Tokyo.
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7
内臓性反射に関する研究
京都大学医学部外科学第 2講座（青柳安誠教授指噂）
渡 辺 裕
l
. 内臓痛の場合種々の反射性随伴現象 が 現 わ れ
る．内臓痛の適邪l
銭としてアセチ Jレコリン（ Ach）注
v
抑制作用を量する．即ち自律神経緊張度の高い方を抑
制す る
．
射法，電気銅l
戟，機械的事j
l
戟を用 、，動物では呼吸運
6
. 内臓運動反射は最も簡単な反射弓を形成し，去
動，瞭孔散大反射，胃腸運動抑制j
反射，内臓運動反
脳猫の内臓を朔l
敏時，両側直腹筋は略々同程度に収縮
射，血圧反：；~ ，恒吐の随伴現象を指標として 脊髄以下
し，且つ闘刺戟時には各消化管部位に応じて断区的に
末梢の内臓知覚路を検討した．
反応し，後根切断実験の結果 と類似して居る．
え呼吸運動，眼孔散大反射を指標とした場合，主
一側究感神経切除後回側の直腹筋収縮は低下し反対
に廻腸からの求心路は①内臓神経，脊髄後根，脊髄，
側は元通り であり，両側切除時内臓運動反射は消失し
①交感神経節状索，交通校，③迷走神経であった．
た．即ち究感神経に関 Lて求心性支聞は大部分間側
3
. 去脳1
苗，無麻酔猫の n
匝吐の主求心E
告は迷走神経
性，一部交叉性でらる．之は人体に於いて 1側胸服部
で，交感神経も之に与り， R
阪吐は腹膜症状 と解するよ
交感神経切除後の内臓痛反対側移動と一致する．叉人
りも内険性叉は迷走神経症状と云うのが適当である．
体の腹壁の正中線附近は左；
街貫複性に求心性支配を受
又1
直吐直後の血中自律神経作用物質はむしろ a
d
r
e
n
e
-
け腹部皮膚上の一点の部位感覚｛右か真中か左カサが
r
g
i
cである．
生ずるが， 1側で開腹術をうけ神経の切断された場
4
. Ach液の腸管壁滴下及び注射時，腸間膜動脈内
合，術後は皮！醤上の部快感覚は対側に移動する．即ち
注射時血圧上昇．を来し，筋肉内及び静脈内注射時には
基準にな る部位感覚の移動が起る．以上三者の聞には
血圧下降を来し，前者は交感神経性反応であ り且つ人
基本的な類似が存する．
体では内臓痛として感す．る．
5
. TEABに依り侵害反射は血圧以外，影響を受け
ない．臨床的に内臓痛の寛解する事の多いのは，一部
腸管運動の抑制作用に依るが， TEAB
は，腸管運動に
対し両働性に作用し，促進的と認められる状態の時に
7
. 人体虫垂のAch東J
I
戦時内臓痛放散都l
士
， Th5
10
殊にThs・9のデ Jレマトームの部であり，叉，虫垂の痛
みには関連痛の他に莫の内臓痛も存する様である．
本研究は女部省科学研究費の補助を受けた．