CASE OF DEFORMITY PROBABLY FROM DEFECTIVE NUTRITION.

307 waters of the ocean, whose flora is said to rival in extent, and to surpass in beauty, that of the earth in many instances. By its assistance we are enabled, in a great

majority of flowering plants,

CASE OF DEFORMITY PROBABLY FROM

DEFECTIVE NUTRITION.

at least to de-

By J. R. SMYTH, M.D., Banbury.

tennine with tolerable accuracy, the name and other circumstances of a vegetable

or to form clearer ideas of those RICHARD AYRIS, who forms the subabsent one, from description, than of this sketch, resides in a village a can be formed in any other way,-the few miles from this place. He is now science thus obviously supplying the best twenty-one years of age, and twentypossible substitute for personal observa- eight inches in height. His mother, who tion of the vegetation of foreign climes. has several other children, gives the folFrom it we learn not only the external of this extraordinary youth. lowing history forms, but also the latent mechanism by She states that he was born at the nawhich the oak matures into the monarch of the forest, and the rose develops its beauty tnral period of gestation, and that he was and emits its fragrance; how the hum- then a large, strong, and healthy child, ble mosses, or lichens, attach, maintain, and continued to be strong and healthy and reproduce themselves in situations till he was three or four months old, when where the Protean energy of vitality alone he had a severe attack of illness, the nais capable by its infinite resources of over- ture of which his medical attendant did not coming the difficulties opposed to their comprehend, and which had nearly proved ’ fatal. From that time, as the mother existence. By the light which it thus sheds on the ’ herself expresses it, "the constitution of structure, physiology, and peculiar habits, the child appeared to be entirely altered;" of plants, we are enabled to select from, he was always pale, listless, and inactive, and to improve on, the bountiful pro- but he advanced slowly in growth till he fusion of the vegetable race provided for was between two and three years of age, almost all the exigencies of animal life, by , since which time his bulk has been staand he has been in all other recultivation and experiment; to convert ’ the austerity of the crab into the grateful spects,-in appearance, health, and habits, acidity of the apple and the pear; to va- -exactly as he is at present. riegate the flower with tints still fairer clergyman who has visited this boy than its own; and to cull the salutary during the last sixteen or eighherb or fruit, from amidst contiguous poi- teen years, states that he can scarcely sons, or less noxious companions, for the observe that any change has taken place alleviation or prevention of disease. In either in his appearance or in his intellect fine, we have been placed in a garden, full since he first saw him. of beauty, full of excellence and interest, 1 shall now give a brief description of but, withal, dark, mystic, and inextricable as present condition of this alabyrinth. We may, tis true, feast the eye, particularly of his internal or pathothe and revel on taste, gratify sensually from which perhaps we , logical tis so to the repast profusely supplied us; ’ may be condition, able to collect some information science, however, which, by clearing away the original cause of his dimi. the darkness around these objects, and by regarding : nutive development. endowing us with an additional sense, The head and abdomen, as the portrait throws new charms over the indulgence of all the rest, makes enjoyment, grati- exhibits, are large, and considerably out of tude, contemplation, religion, and study, proportion to the thorax and extremities, a sublime and appropriate homage of that the latter parts as well as the genital ordivine Architect who has designed and gans being still in their infantile state of executed the vast assemblage of beings, development. The head most likely is a amazing in their number as in their na- little dropsical. The countenance is dull, ture, from which we derive all these ad- listless, and abstracted, the cheeks are vantages. That science, Gentlemen, is pale and puffed, the lips are thick and livid, and around the eyes the skin is BOTANY. somewhat blue. The mouth is generallv LARGE MEALS require muchrest. "The open, and the tongue, which is large and When taking food, how. extreme prevalence of dyspepsia and in- livid, protrudes. he draws in his and when sanity in America (Combes Physiology ever, and shutsdesired, his mouth, which, as tongue is applied to Health) probably partly owing would be anticipated, gives a considerable to hasty swallowing, and speedy return to He business." The remedy consists in small improvement to his countenance. cannot, indeed, been his mouth shut more meals.

present, of

an

ject

! tionary,

A

frequently

the more

individual,

308

a few seconds at a time, as this abstruse. Memory, the only internal seems seriously to interfere with the func- sense which he seems to is stated ion of The anterior naresto be retentive, he recollects any person are expanded and elevated. He has had whom he may have seen once before. but one imperfect set of teeth, eight in the His desires are childish, he is amused by upper jaw, and four or five in the lower, all sorts of toysand glittering objects, but, which are now decaying, and falling out. like the majority of his brethren of a The sutures of the skull are still ununited, higher order of development, money afand the anterior fontanel is very large. fords him the greatest pleasure and amuseIn short, the evolution of every part of ment. When presented with a piece he the body, both as regards its structure will smile, and return thanks by kissing and its volume, is purely infantile. Al- his hand. He always feels cold, and the though almost a man in years, he is still i hottest day in summer cannot compel him but an infant in organization. to abandon the fire,

than

possess,

respiration.

He can stand and walk by holding a His surface and extremities are dry, person’s hand. the chest being at the same rough, and cold to the touch. The pulse tune inclined backwards, to balance his at the wr ist is just perceptihle, between large protuberant abdomen. His muscles ninety and one hundred, weak and thready, are soft and flabby, and in all his moneand bowels but regular. The stomach ments he is exceedingly sluggish. These, iare always irregular. The evacuations indeed, areas slow as those of a tor- from the latter are stated to be, for the toise. He is dumb, but his want of part, fluid and light-coloured. The speech does not depend upon his being liver is much enlarged. No evidence of deaf, as is generally the case, for his senseascites. The urine is stated to be toleof hearing, as well as the rest of his ex- rably natural in quantity and quality. He been, for some years past, at times, ternam senses, is tolerably correct, though

most

has

309 troubied with a slight cough, during theovale. The faint circumscribed sounds cf presence of which, more thau once or vthe left ventricle, with the weak thready been observed pulse, plainly show, however, that that swollen. He sleeps tolerablycavity, and the arterial system throughout, ! are well, and in the recumbent position. scantily supplied with blood. The affection, then, of the thoracic orAuscteltation of the Chest.—Lungs; the gans of which we have seen this hoy new respiratory murmur is faint, and I think to be the subject, I am fullv inclined to accompanied by a slight sonorous rale. think is not of recent development, hut, Heart; action of both ventricles tolerably on the contrary, that it has existed in a regular. Impulse, if any, very slight. form, more or less intense, since his inSounds. In the epigastric region, along fantile years; ancl, moreover, that we the greater part of the sternum, and on must regard it as the original cause the left side of the thorax, stretching up of his present diminutive stature. My to near the corresponding clavicle, the reasons for taking this view of the matter sounds are loud and abrupt. Along the I shall here explain. If we test the princourse of the sternum, however, those cipal facts or events in the history of the phenomena are superficial and most au- case with what we are aware would have dible. On the left side of the thorax, op- been the pathological, or, rather, the phyposite the left ventricle, the sounds are siological effects on the infant and growcomparatively weak and circumscribed. ing constitution, of a joint lesion of the The jugular veins are much and perma- respiratory and circulatory apparatus, such nently distended. When he struggles and as in this hoy now exists, they afford, I cries, which he is too apt to do on the ap- presume, such mutual and confirming supplication of the stethoscope, hisface be- nort to each other that we can scarcely take any other view of the matter. The comes purple and congested, and this facts I allude to in the history of the case terminates generally in a few attempts to vomit, which process, how- are these: 1 st. The hoy, when born, was ever, he does not appear to be able to strong, perfect, and healthy, and continued complete, from want of power in the mus- so to be till he was a few months old. cles of the abdomen. 2nd. About that time he had a severe ittack of illness, which was observed to have Diagnosis.—Much passive dilatation of, produced,a complete change in his constitheright cavities of the heart, with the na- tution. 3rd. From the time that lie was tural, or perhaps a slightly hypertrophied, between two and three years of age, up to state of the left. Obstruction of the ori-the present date, his external condition fice of the pulmonary artery, and pates- has undergone no appreciable alteration ; cence, perhaps, of the foramen ovale. En- in other words, he was, eighteen years ago, as far as external observation could (iclarged liver. tect, exactly what he is at present. Remarks. With regard to the second oi the above What the exact nature of the organic facts, we may safely conclude, I conceive, region is, or when or where in the course without much fear of being incorrect, of the pulmonary circulation the impedi- that no lesion or derangement either of ment is situated, which obstracts the function or of organization of any other course of the blood from the right cham-,part of the system, which might have ocbers of the heart, it is difficult to deter-curred during the early life of this indimine. The turgid state of the jugular vidual, could so immediately and so effecveins, and the loud, abrupt, and extended tually alter his constitution and arrest its sound of the right ventricle, clearly show growth, as the lesion of the respiratory apthat that cavity is much distended, and paratus which now exists and which we that the blood is stagnated in it and in theare now considering. The third fact corresponding auricle and continuous requires a remark, but we may that since the external condition venous trunks. of this boy has undergone no metamorThe enlargement of the liver is a mon effect of such a state of the circula- phosis since his infancy, it is not unreation. The sternal sounds, with the geneto conclude that his internal conral symptoms, lead me to suspect that the has been equally unchanging. orifice of the pulmonary artery is partially This view of the case, I am aware, involves pathological circumstances, which, obstructed, and that the principal part the blood makes its way from the right to ’i it must be confessed, are of extremely rare the left side of the heart, without previnamely, to find a child the ously going the round of the pulmonary subject of organic disease of the heart, and ta find that disease, no matter who circulation, and that, perhaps, this takes have been the subject of it, continuplace by means of the pervious foramen

twice, his legs and feet have to become

’

state

ineffectual

I

Iobserve scarcely

com-

sonable I dition

of!

occurrence ; also : may

310 of twenty years. This then to be regarded as a dwarf? No, latter circumstance, however, I conceive, for the term dwarf is restricted to those receives an explanation in the effects of individuals whose diminutive stature de. the disease upon the system generally,’ pends not on malformation or disease, having acted in a palliative and salutary but in a proportionally diminished volume How then is manner upon the disease itself. The pros-,of all the parts of the body. tration of the circulation of the vital liow- i case to be regarded ? As one, I think, ers, and the early arrest of the develop- presenting us with an example of arrest ment of the locomotive organs, consigned nutrition and development in consei the individual to a passive mode of ex- quence of disease, from early failure of the istence, which of course prevented him function of respiration, the effect of orfrom making any sort of exertion that ganic lesion of the respiratory organs, heart and lungs. might at any time have accelerated the. circulation, and, consequently, aggravated Considerable instruction may, I prebe derived from this case in a phythe affection. So that, in this nature has fairly verified the principlessiological and therapeutic point of view. inculcated by art, and adopted a complete Does it not fully and distinctly demon. and rigid Valsalvian mode of discipline, strate the relation which exists between which, though it has not been effectual inthe development of the function of reworking out a cure of the disease, has spiration and the development of the at least proved useful in retarding its pro-’ animal system, the system of support and the bones, muscles, brain, and gress and fatal termination. Nature, as it were, has sacrificed the animal system to nerves ? Does it not, too, perhaps, show preserve the organic. I may here observethat the primary and principal cause of that it is evidently the want of (for this, if we confine our obserpower in the lips and tongue which pre- vations to the osseous system alone, is a vents this boy from being able to articu- case of aggravated rickets), curved spine, late. He attempts to speak, but and spina bifida, with various other affecgive the necessary quick motions to thosetions of the organs of support, is to be for in some lesion of the respiraparts. This case is interesting, perhaps, tory apparatus ? I think it does. How another point of view. It presents us, I necessary then must it not be to be aware I think, with a fair illustration of a of the state of those organs in thetreatment law propounded hy MM. Serres, Saint- of disease situated in any part of the body ? Hilaire, Beclard, Andral, and others, in Who could vouch to cure a chronic abexplanation of the cause of one class of scess, an indolent ulcer, or cause an unfracture to coalesce, without first bemonstrosities, namely, those from arrest of development. The law is this, " That iing aware of the condition of the heart and the absence or incomplete evolution oflungs ? We have here full proof, if proof any part of the system depends on thewere wanting, that it is the function of which determines the energy defective development of the artery which the nisus forynativus, and that which should supply the part with the materials for its nutrition and growth." In the affects the formative power must necespresent case, however, the arteries are sarily, and does certainly, affect the represent but they do not convey the material storative, as these are but different terms (red blood) for the nutrition and growth implying the same physiological action. of the organs and during foetal life also. IThese remarks call to my mind a case of will venture to say, that it is the defective’old ununited fracture of the femur, in a development of the blood (if I may use’man aged 40, which I witnessed not long that expression) which causes the defec-:v:since in one of our metropolitan hospitals. tive development of the arteries ; the!’ For the purpose of causing the ends of the to unite, the limb was bound firmly latter is formed from and for the former.bones !, The question then naturally arises, Should in splints, and the patient was kept some this individual be regarded as a mon-months in bed; his mouth was affected with mercury, but all to no purpose; strosity ? and the answer must be in the negative. The period at which the arrest the fracture still continued ununited. He of development took place, having been died shortly afterwards, and in the ausubsequent to the birth of the boy, pre- topsy the lungs were found to be studded cludes him from being ranked under the with tubercles, and a tubercular cavity term monstrosity, it being necessary, ac- was discovered in the substance of one of cording to systematic and scientific lan- the lobes. Was it this state of the lungs, guage, that a malformation should be con- then, which prevented an osseous union genital to merit that appellation. Is he from taking place ?

ing during a period

this of

the

instance,!r! sume,

locomotion,

muscularrickets

cannoti

insought iunited

respiration

of

twice

Banbury, Oxfordshire,

.

Yide Attdt’at’: Pathol.

Anatomy, p.

136.

13th May, 1834.