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THE PULSE, RESPIRATION, AND HEAT.
794 but the other senses appear ito the original papers contained in this ex" i modified. Thus they support the cellent equally journal for the lat trimestre. They sensation of cold and heat with an astonish- !are, 1st. Researches on some of the causes that ing indifference; a heated iron applied to the skin produces scarcely any sign of suf- hasten or retard the period of pubertyby M. MARC D’ESPINE. fering ; they are indifferent to the loudest i 2. Conclusion of Researches on Dysensun without blinknoises; they regard the sery. By M. THOMAS. ing, and all the other senses are in a similar 3. Researches on the Pulse, the Respiradegree of stupor. The following case, which tion, and the Temperature of the Body in and on the Relations existing be. we quote from the memoir of M. GUISLAIN, shows that when the mental state has not tween these Phenomena. By M. A. DONNE, Chef de Clinique. made too great progress, we may hope to 4. On the Physiological and Essential overcome the resistance of the patient, and Effects of the Rarefaction and Compreseven when the pulmonary lesion is very sion of the Air on the Body or Limbs. By grave, an unexpected cure may take place :- M. T. JUNOD. 5. Memoir on Pericarditis. By M. Case.- Marie de Leest, descended from a Interne. HACHE, family in which several members were mad, 6. Clinical Researches into the Diseases was seized with a deep melancholy while in the establishment of the author. The pa- of Old Persons. By Messrs. HouRMANN tient was 28 years of age, of very delicate and DE CHAMBRE. 7. Researches on the Movements of the complexion, blue eyes, and light hair. Two By M. BEAU, Interne. months after her entrance she commenced to refuse all kinds of food ; three days passed THE PULSE, RESPIRATION, perfect abstinence. Threats and entreaties were employed in vain. At length force was AND HEAT. had recourse to, which succeeded twice; but We present our readers with the paper the patient soon offered such violent resistance that the liquid was retained in the by M. DoNNE, on the relations which exist pharynx, and after some time rejected by between the pulse, respiration, and animal the mouth. The introduction of a tube into heat, in different diseases. the oesophagus was impossible. The same The experiments which form the basis fruitless efforts to introduce a little food were of this memoir, were conducted at the hosrepeated day after day ; sometimes, perhaps, a few spoonfuls of broth were passed. The pitals of La Pitic and La Charité, with the colour of the face now commenced to as- object of determining how far the pulse, the sume the pathognomic character. The force respiration, and the heat of the body, are declined gradually, and after two months affected simultaneously or independently in spent in complete abstinence she com- several diseases. For a statement of the menced, without any previous cough or difficulty of respiration, to spit up fetid matter, numbers ascertained during the great series at first rusty-coloured, and finally brown. of experiments made by M. Do NNE, we must At this time she did not eat a single morsel refer to his memoir. Our space will only of food, as we were afraid to employ force permit us to notice some of the general relest suffocation should be produced. How- sults which have been obtained. The exever, after remaining some time in this conwere made on persons affected dition, she suddenly determined to eat, and periments with pneumonia, pleuritis, phthisis, hyperthe face recovered its in a few days former pale colour ; the sanguineous fetid expec- trophy of the heart, hemoptysis, chlorosis, toration ceased by degrees, and the patient diabetes, puerperal fever, hemiplegia, hysat length recovered a perfect state of health. teria, jaundice, &c. She left the house in 1829, but came in again The first question examined was, in what in 1831. This time also her disease was diseases do we find the pulse most frequent, characterized by a refusal to eat, and by puland the animal heat most elevated? The under which she sank. On disease, monary opening the body, the left lung was found following numbers, selected from amongst a reduced to a dark and fetid mass. great many experiments, answer this first rent to
hunger,
I Diseases,
inHeart.
Archives Gensrales de Médecine,
September,
question:-
Tempe- Respira. RespiraPulse. rature. tion. October, November, December, 1835. of the 150 .. Hypertrophy of other us on matter The press 39!.. 34. prevented heart......... } aformer occasionfrom noticing more than one Puerperal fever .... 168 ..40 .. 48. or two articles contained in the last four num- Phthisis 140 .. 39 62. bers of the Archives Gernerales. We now return Typhus fever ...... 136.. 40 .. 50. ’
..........
795 In the normal state of the body* cases were those in which the and heat. and heat had attained the highest de-- we do not find this close connection between gree of elevation ; the latter was measured the pulse and animal heat; this is easily by the centigracle thermometer, thirty-six proved by experiments, which every one to thirty-seven degrees of which give the can perform on himself; we can make the normal temperature of the human body. It pulse mount fifteen or twenty beats in the may be seen, from the above table, that the minute, without producing the least change acceleration of pulse was always accompa- in the temperature of the body. In cases nied by an elevation of temperature; the of disease this is not the case, the heat is skin is most warm in those indivi- elevated with the quickness of the pulse; duals in whom the pulse is quickest; this but here an interesting question, which has rule, however, cannot be generalized too never been examined by physicians, pre" extensively; it is not true in all diseases. sents itself. Does this relation between the Thus M. DONNE gives forty-two experi- pulse and heat exist more in one disease ments made on patients affected with pul- than in another? Is it influenced by the monary tubercles ; in twenty-six we do not nature of the disease ? Thus, for example, find any relation between the temperature does it depend on the integrity of the organs and pulse; in sixteen cases only, the animal of sanguification, of the nervous system, or heat fell or rose in proportion to the slow- of any other apparatus ? ness or acceleration of the pulse. These questions are resolved by the tables Again, in ten observations made on pleuritic patients, given by M. DONNE. Thus, in tubercular we cannot discover any relation between the affection of the lungs, and in pleurisy, the state of the pulse and the degree of heat ; relation between the pulse and heat is more on the contrary, in seven experiments made frequently absent than present. In chlorosis, in pneumonia, the heat constantly rose with again, we do not observe this relation; the the pulse. The same relation was observed latter disease, indeed, does not belong to the in twelve experiments on patients affected pulmonary organs, but sanguification may with hypertrophy; in eleven experiments be regarded as imperfectly performed. In on puerperal fever; in four experiments on organic affections of the heart, such as hyjaundice ; in six experiments on acute rheu- pertrophy, contraction of its valvular openmatism ; in five experiments on inflamma- ings, &c, the relation is not constant, but tory fever; and, finally, in six experiments it is more frequently present than absent. In fourteen experiments On the other hand, in puerperal fever, in on typhus fever. made on females affected with chlorosis, hemiplegia, jaundice, inflammatory fever, the relation of the pulse and heat was by no ague, and peritonitis,the relation between the means constant. pulse and heat was almost constantly obThe above numbers confirm, in an exact served. In the theory of animal heat, such manner, an opinion generally received as it is generally admitted at the present amongst physiologists, although it never day, after the researches of MM. DULONG before was proved by direct experiments on and DESPRET, the augmentation of the ania large scale-viz. that the animal heat often mal heat may be attributed to the acceleraascends or descends with the pulse. They tion of the circulation. In this theory, ninealso prove another point, which is contrary tenths of the heat in animal bodies is atto the ideas generally received. They show tributed to the combination of the carbon of that in some cases there is no proportion the blood with the oxygen of the air, and whatever between the number of pulsations hence the more quickly the blood passes and the degree of heat, although the relation through the lungs, the more carbonic -acid of ascending and descending may still exist. will be formed, and the more the heat of Thus, in one case of typhus fever, the pulse the body is elevated. However, some strong being at ninety, the thermometer marked objections may be made to this theory. In thirty-nine degrees ; and in another where the first place, it is remarkable that one of the pulse was up to 108 it marked 40°, the the diseases in which the animal heat is most maximum of heat in the human body. M. elevated, is precisely that in which sanguifiDONNE, however, remarks, that typhus fe- cation is most imperfectly performed : thus, ver is the only disease in which he observed in pulmonary consumption, the heat of the this great disproportion between the prise body often rises to 380, 390, or 40°, even,
The above
pulse
796 one half or two-thirds of the lungs taken place in the cavity of the chest. Pain indurated, and impermeable to air. in the p ecordial region seems to be a sympmuch more frequently existing than Again, the experiments made in typhus tom authors generally describe it to be. Thus fever, show that the animal heat depends on in all the cases observed hy M. HACIIII,, the other sources than sanguification and assi- development of pericarditis was marked by milation ; in that affection, certainly the some pain, at times slight, near the left mampulse is not always much accelerated, nor ma. The same result is obtained by exthe respiration very quick, yet we find the amining the twenty-two cases detailed by M. Louis and M. BOUILLAUD, while in a heat of the body mounting in one case to moiety only of those published previouslyto 390, with a pulse of 93; in a second case, the memoir of M. Louis in 1826, the preequally to 390, while the pulse was at 108, sence of pain about the precordial region is mentioned. Palpitation is another symptom and the respiration at 28. M. DONNE proposes to follow up these which frequently attends pericarditis. It, indeed, mentioned by all -writers, but it interesting inquiries. We shall take care to is, may not be useless to give, what we may communicate his observations as they apcall, some statistical notes of this symptom. It was present in an the eight cases of M. pear. HACHE. In the twelve cases of pericarditis published by M. Louis, it is mentioned six PERICARDITIS. times. Thus we have palpitations existing in fourteen out of twenty cases. However, The memoir on pericarditis, by M. HACHE, if we the twenty-eight cases pubis an excellent resun2t5 of the present state lished analyze by M. BouiLLAUD, we find palpitaof our knowledge on pericarditis, by an old tions mentioned only three times. How is interne of M. Louis. The conclusions to this great difference to be explained? In which he comes are based upon eight cases many cases of pericarditis, the palpitations or attract the do not cause much
where
I
are
pericarditis, observed with all the care patient’s attention, distress, and we think with M. peculiar to the pupils of M. Louis’s school; Louis, that if palpitations are not menof eight more cases, collected by M. Louis tioned by M. BOUILLAUD in more than between 1830 and 1833 - and, finally, on an three cases out of twenty-eight, it is because examination of these original observations his attention was not directed to that point. with those published very lately by Profes- This circumstance shows the necessity of noticing, as well those symptoms which are of
It is not our sor BOUILLAUD of La Cfaarite. intention to go over details already sufficiently knowrl to the profession, we shall therefore merely notice a few principal points in the memoir of M. HACHE.
absent as those which are present, if we desire a case to possess the full value of which it is capable. It is a point upon which M. Louis insists with some earnestness, and is one of which English writers are by far too
negligent.
observed by our author may be The rational signs of pericarditis are, as distinguished into two kinds ; one where the we have before said, insufficient to demondisease was simple; the other in which the strate the existence of this disease: fortupericarditis was accompanied by various nately the physical signs are much more complications. In the first of these forms certain ; they are given at length, and with the disease appeared in such a manner, thatclearness, by M. HACHE. Before entering if we were to be guided by the description on an examination of these signs, we should given in any of our standard medical trea- mention that the author seems to refer contises, it would be impossible to detect,stantly to cases of pericarditis with abunor even to suspect, the existence of inflam- dant effusion, and not to the dry variety of mation of the pericardium. Thus the pre- Dr. STOKES. Oneof the tlrst physical monitory symptoms were mild, consisting in symptoms worthy of notice is a prominence some pain in the precordial region, a little’ over the precordial region, depending evicough, and very slight fever, which did notdently on protrusion of the soft thoracic prevent the patients from pursuing theirparietes by the distended pericardium ; this ordinary occupations, or even laborious em- symptom was very well marked in five of ployment. After one or two weeks theyM. HACHE’S cases. In one it was slight; came to the hospital on foot. Nothing inL in two young girls it could not be deterthe patient’s countenance of a generalbear- min ed ; hut there the disease was very slight, ing, indicated the existence of a severe ma- and if a small difference existed between lady ; the face was calm; the skin quitethe two sides of the chest, it was masked cool; the pulse moderate, and, we again by the volume of the breasts. repeat, without the assistance of percussion Sonority of the Chest.—In all cases perand auscultation, it would have been quite cussion gave a dull sound over the whole of The
cases
impossible
to detect the
change which
hadthe
precordial region,
and above tlis,
along
,
hunger,
I Diseases,
inHeart.
Archives Gensrales de Médecine,
September,
question:-
Tempe- Respira. RespiraPulse. rature. tion. October, November, December, 1835. of the 150 .. Hypertrophy of other us on matter The press 39!.. 34. prevented heart......... } aformer occasionfrom noticing more than one Puerperal fever .... 168 ..40 .. 48. or two articles contained in the last four num- Phthisis 140 .. 39 62. bers of the Archives Gernerales. We now return Typhus fever ...... 136.. 40 .. 50. ’
..........
795 In the normal state of the body* cases were those in which the and heat. and heat had attained the highest de-- we do not find this close connection between gree of elevation ; the latter was measured the pulse and animal heat; this is easily by the centigracle thermometer, thirty-six proved by experiments, which every one to thirty-seven degrees of which give the can perform on himself; we can make the normal temperature of the human body. It pulse mount fifteen or twenty beats in the may be seen, from the above table, that the minute, without producing the least change acceleration of pulse was always accompa- in the temperature of the body. In cases nied by an elevation of temperature; the of disease this is not the case, the heat is skin is most warm in those indivi- elevated with the quickness of the pulse; duals in whom the pulse is quickest; this but here an interesting question, which has rule, however, cannot be generalized too never been examined by physicians, pre" extensively; it is not true in all diseases. sents itself. Does this relation between the Thus M. DONNE gives forty-two experi- pulse and heat exist more in one disease ments made on patients affected with pul- than in another? Is it influenced by the monary tubercles ; in twenty-six we do not nature of the disease ? Thus, for example, find any relation between the temperature does it depend on the integrity of the organs and pulse; in sixteen cases only, the animal of sanguification, of the nervous system, or heat fell or rose in proportion to the slow- of any other apparatus ? ness or acceleration of the pulse. These questions are resolved by the tables Again, in ten observations made on pleuritic patients, given by M. DONNE. Thus, in tubercular we cannot discover any relation between the affection of the lungs, and in pleurisy, the state of the pulse and the degree of heat ; relation between the pulse and heat is more on the contrary, in seven experiments made frequently absent than present. In chlorosis, in pneumonia, the heat constantly rose with again, we do not observe this relation; the the pulse. The same relation was observed latter disease, indeed, does not belong to the in twelve experiments on patients affected pulmonary organs, but sanguification may with hypertrophy; in eleven experiments be regarded as imperfectly performed. In on puerperal fever; in four experiments on organic affections of the heart, such as hyjaundice ; in six experiments on acute rheu- pertrophy, contraction of its valvular openmatism ; in five experiments on inflamma- ings, &c, the relation is not constant, but tory fever; and, finally, in six experiments it is more frequently present than absent. In fourteen experiments On the other hand, in puerperal fever, in on typhus fever. made on females affected with chlorosis, hemiplegia, jaundice, inflammatory fever, the relation of the pulse and heat was by no ague, and peritonitis,the relation between the means constant. pulse and heat was almost constantly obThe above numbers confirm, in an exact served. In the theory of animal heat, such manner, an opinion generally received as it is generally admitted at the present amongst physiologists, although it never day, after the researches of MM. DULONG before was proved by direct experiments on and DESPRET, the augmentation of the ania large scale-viz. that the animal heat often mal heat may be attributed to the acceleraascends or descends with the pulse. They tion of the circulation. In this theory, ninealso prove another point, which is contrary tenths of the heat in animal bodies is atto the ideas generally received. They show tributed to the combination of the carbon of that in some cases there is no proportion the blood with the oxygen of the air, and whatever between the number of pulsations hence the more quickly the blood passes and the degree of heat, although the relation through the lungs, the more carbonic -acid of ascending and descending may still exist. will be formed, and the more the heat of Thus, in one case of typhus fever, the pulse the body is elevated. However, some strong being at ninety, the thermometer marked objections may be made to this theory. In thirty-nine degrees ; and in another where the first place, it is remarkable that one of the pulse was up to 108 it marked 40°, the the diseases in which the animal heat is most maximum of heat in the human body. M. elevated, is precisely that in which sanguifiDONNE, however, remarks, that typhus fe- cation is most imperfectly performed : thus, ver is the only disease in which he observed in pulmonary consumption, the heat of the this great disproportion between the prise body often rises to 380, 390, or 40°, even,
The above
pulse
796 one half or two-thirds of the lungs taken place in the cavity of the chest. Pain indurated, and impermeable to air. in the p ecordial region seems to be a sympmuch more frequently existing than Again, the experiments made in typhus tom authors generally describe it to be. Thus fever, show that the animal heat depends on in all the cases observed hy M. HACIIII,, the other sources than sanguification and assi- development of pericarditis was marked by milation ; in that affection, certainly the some pain, at times slight, near the left mampulse is not always much accelerated, nor ma. The same result is obtained by exthe respiration very quick, yet we find the amining the twenty-two cases detailed by M. Louis and M. BOUILLAUD, while in a heat of the body mounting in one case to moiety only of those published previouslyto 390, with a pulse of 93; in a second case, the memoir of M. Louis in 1826, the preequally to 390, while the pulse was at 108, sence of pain about the precordial region is mentioned. Palpitation is another symptom and the respiration at 28. M. DONNE proposes to follow up these which frequently attends pericarditis. It, indeed, mentioned by all -writers, but it interesting inquiries. We shall take care to is, may not be useless to give, what we may communicate his observations as they apcall, some statistical notes of this symptom. It was present in an the eight cases of M. pear. HACHE. In the twelve cases of pericarditis published by M. Louis, it is mentioned six PERICARDITIS. times. Thus we have palpitations existing in fourteen out of twenty cases. However, The memoir on pericarditis, by M. HACHE, if we the twenty-eight cases pubis an excellent resun2t5 of the present state lished analyze by M. BouiLLAUD, we find palpitaof our knowledge on pericarditis, by an old tions mentioned only three times. How is interne of M. Louis. The conclusions to this great difference to be explained? In which he comes are based upon eight cases many cases of pericarditis, the palpitations or attract the do not cause much
where
I
are
pericarditis, observed with all the care patient’s attention, distress, and we think with M. peculiar to the pupils of M. Louis’s school; Louis, that if palpitations are not menof eight more cases, collected by M. Louis tioned by M. BOUILLAUD in more than between 1830 and 1833 - and, finally, on an three cases out of twenty-eight, it is because examination of these original observations his attention was not directed to that point. with those published very lately by Profes- This circumstance shows the necessity of noticing, as well those symptoms which are of
It is not our sor BOUILLAUD of La Cfaarite. intention to go over details already sufficiently knowrl to the profession, we shall therefore merely notice a few principal points in the memoir of M. HACHE.
absent as those which are present, if we desire a case to possess the full value of which it is capable. It is a point upon which M. Louis insists with some earnestness, and is one of which English writers are by far too
negligent.
observed by our author may be The rational signs of pericarditis are, as distinguished into two kinds ; one where the we have before said, insufficient to demondisease was simple; the other in which the strate the existence of this disease: fortupericarditis was accompanied by various nately the physical signs are much more complications. In the first of these forms certain ; they are given at length, and with the disease appeared in such a manner, thatclearness, by M. HACHE. Before entering if we were to be guided by the description on an examination of these signs, we should given in any of our standard medical trea- mention that the author seems to refer contises, it would be impossible to detect,stantly to cases of pericarditis with abunor even to suspect, the existence of inflam- dant effusion, and not to the dry variety of mation of the pericardium. Thus the pre- Dr. STOKES. Oneof the tlrst physical monitory symptoms were mild, consisting in symptoms worthy of notice is a prominence some pain in the precordial region, a little’ over the precordial region, depending evicough, and very slight fever, which did notdently on protrusion of the soft thoracic prevent the patients from pursuing theirparietes by the distended pericardium ; this ordinary occupations, or even laborious em- symptom was very well marked in five of ployment. After one or two weeks theyM. HACHE’S cases. In one it was slight; came to the hospital on foot. Nothing inL in two young girls it could not be deterthe patient’s countenance of a generalbear- min ed ; hut there the disease was very slight, ing, indicated the existence of a severe ma- and if a small difference existed between lady ; the face was calm; the skin quitethe two sides of the chest, it was masked cool; the pulse moderate, and, we again by the volume of the breasts. repeat, without the assistance of percussion Sonority of the Chest.—In all cases perand auscultation, it would have been quite cussion gave a dull sound over the whole of The
cases
impossible
to detect the
change which
hadthe
precordial region,
and above tlis,
along
,