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ESSAYS ON GENERAL PATHOLOGY.
472 sults of percussion are not given. The friction-sound was the treatment of those cases where the blood is imperfectly limited to the base of the heart and was single. It continued arterialized, great care. is to. be taken lest we exhaust the for about seven days and in its last stage, before disappearing, powers of life. In the majority of instance the use of mild it could not be distinguished from a faint bellows-murmur. expectorants, with gentle local depletion, is commonly found The pain was an unimportant feature in the case for it was sufficient to afford relief. We have not simply to contend with trifling in amount and only occasionally present. There was mucous inflammation, but inflammation conjoined with a no evidence of endocarditis, nor of pneumonia. vitiated state of the blood, in which large depletions would 2. Lungs.-There was some consolidation of the apices of speedily sink the powers of vitality. - From the analogy of both lungs, but more particularly of the right one, as was measles, we might suppose that the eruption of syphilis toot shown by the results of auscultation and percussion. The some of its peculiarities from an affection of the mucous mem.. locality of the dulness was that of tubercle, rather than ofbranes. The dingy colour of the spots, in secondary syphilis, pneumonia, and the history of the case was calculated to lead would give the idea that the blood was imperfectly arterialized. us to the same conclusion respecting the nature of the disease. There can be no doubt that there is often a pulmonary comThere had been some cough, expectoration occasionally tinged plication in this complaint; at the same time, in the majority with blood, and loss of strength for about two months previ- of cases, it does not seem to demand any very active treatment. The following quotation from Dr. Stokes’ able work on the ously. Causes.—1. Of the Rheumatism.-The previous attack ofDiseases of the Chest, may be found interesting in this place:rheumatism, the inadequate clothing, and sleeping habitually " The syphilitic poison, in its action on the viscera, seems in a cold room, would predispose to the present attack, which more often, or at least more prominently, to affect the respithe patient attributed to exposure to draughts of cold air. ratory system. Thus, the frequency of laryngeal affections in 2. Of the Pericarditis.-There was nothing but the rheumatism syphilis has been long admitted, to which I shall again allude towhich this could be ascribed. There was no metastasis, for the in speaking of diseases of the windpipe. With respect to the rheumatism became rather worse than better, when the peri- bronchial system, we may observe the disease as an acute or carditis supervened, and it continued long after this time. The more chronic affection. In the first instance,it is analogous to rheumatism was sub-acute and the fever moderate. the irritation of the exanthemata, of which I have seen a few Treatment.—Calomel and Dover’s powder were given, night interesting examples; while, in the second, there is a chronic and morning, for the rheumatism, and house-physic every irritation, which, when combined with the syphilitic hectic, morning. On the 19th, the rheumatism being worse and ac- and with periortitis of the chest, closely resembles true pulcompanied by occasional pain in the region of the heart, twelve monary phthisis. In the first of these cases, I have observed ounces of blood were taken from the arm, and eight ouncesthat, after a period of time from the first contamination, the Theduration of which has not been determined, the patient falls more were taken on each of the two subsequent days. friction-sound ceased soon after the gums became tender, butinto a feverish state, and presents the symptoms and signs of it had been gradually declining for several previous days. Thean irritation of the bronchial membrane; these having conrheumatism proved more obstinate, and for it the patient usedtinued for a few days, a copious eruption, of a brownish-red in succession, wine of colchicum, iodide of potassium, decoc-colour, makes its appearance on the skin, and the internal tion of bark, warm baths, and lastly, iodide of iron. The painsaffection either altogether subsides, or becomes singularly lessened. Here we see the bronchial membrane taking on an in the limbs continued long after the gums became tender. Duration.—The rheumatism existed five days before admis-action which is peculiar, and very different from its ordinary The pericarditis, irritations. There is an inflammation only analogous to that sion and, more or less, for twenty days after. appeared on the thirteenth day of the rheumatism and con-of the exanthemata, and no doubt can exist that it is connected with the syphilitic poison."* The well-known sympathy tinued about eighteen days. which exists between the skin and mucous membranes renders it probable, at least where the complexion is of a dingy aspect, that the bronchial lining is in some degree affected. IndeESSAYS ON GENERAL PATHOLOGY. pendent of the mere colour of the eruption, there is certainly a. By J. BOWER HARRISON, Esq., M.R.C.S.L., &c., late Surgeon to peculiarity in the complexion of those suffering from secondary the Ardwick and Ancoats Dispensary, and formerly one of thesyphilis, by which they may be easily recognised. The Resident Medical Officers of the Manchester Royal Infirmary.countenance has a sallow, dusky appearance, so that, when a few faint spots are also visible, the complaint can seldom be No. XIII. mistaken by those who have paid attention to the physiognomy
I
ON
THE
ASSOCIATION
OF
INFLAMMATION
AND
of disease.
ANÆMIA WITH
stages of typhus fever, where the tongue has a, appearance, the skin assumes a dusky colour, for WHEN we spoke of inflammation we, of course, spoke of it ini the condition of the lining membrane of the bronchial tubes is the abstract; but its connection with other forms of diseasevery similar to that of the mouth and fauces, and such as to obviously depends much on its locality and intensity. A veryT interfere with the perfect arterialization of the blood. The common seat of inflammation is the lining membrane of thelate Dr. Armstrong, who devoted much of his attention to the bronchial tubes; and it is apparent that when inflammation1 subject of fever, regarded this peculiarity of the bronchial exists in this situation, it must interfere materially with the; membrane, in the advanced stage of typhus, as very intimately proper arterialization of the blood. In this manner, bronchitis,, connected with the manifestations of the complaint in many of when of long continuance, greatly prejudices the healthyr its phases. I am much inclined to agree with him in supquality of the blood, and produces, or at any rate, favours, thatt posing that the coma and insensibility of fever are often much state of depression and debility which accompanies many of the; aggravated, if not, indeed, produced, by the existence of an auctions of old age. The coldness and lividity, as well as the: especial affection of the bronchial tubes. ’’ The bronchial cerebral confusion which also attends such diseases, are, in like lining," says he, 11 is invariably found highly-congested with dark blood; and a sticky secretion, which besmears the memmanner, traceable to the vitiated state of the circulation. The dependence ofa deranged state of the blood on thea brane, exercises a most important influence over the pathology presence of inflammation is further evident in many of the3 of the affection, by changing the constitution of the blood in a eruptive diseases. In the complaint called measles, for ex-way which I have already explained. If the sticky varnish be ample, a specific poison operates on the system, which appears,, washed off with a sponge, the membrane exposed to the air amongst other effects, to produce an inflammatory condition1 soon becomes vividly red." of the mucous membranes. The mucous surface of the bronchial1 Another morbid association which inflammation acquires tubes is especially implicated, and, partly owing to theinflu-from its particular position is that of an implication of’ the 8 nervous ence of the febrile poison on the blood, but chiefly to the system. Many of the complaints called neuralgic are, existence of bronchial inflammation, the healthy changes in thein reality, of a mixed character, and owemuch of their severity lungs are imperfectly carried on. We find, therefore, thee to inter-current attacks of an inflammatory nature. It would accompanying eruption characterized by this improperly de-- lead us into considerable practical error to look upon hysteric carbonized state of the blood. The lips and cheeks are of aEL affections as altogether unconnected with inflammations and dusky hue, and the rash of a dingy-red or purple tint. Thee congestions; for though they may be entirely free from brain, also, suffers more or less, and hence the state of stuporr such complications, it is also quite possible that some of and want of energy which commonly indicate the affection.,- the symptoms, called nervous, areabsolutely due to these The production of nervous agency, and even of vitality itself, lesions. I have had reason to suspect, in certain obscure casesIn
OTHER CONDITIONS OF DISEASE.
seem
greatly dependent
nor can
it be
a
on
the presence of
some
glazed dry
healthy blood;
matter of wonder that this condition should be
productive of considerable debility. It thus happens that, -in
*
Stokes
on
the Chest,
&dag er; Lectures by Rix,
p.
93.
p. 564.
473 spinal disorder, attended with painful spasmodic action,, of blood, and probably there is a consequent diminution in the occurring in persons of a rheumatic diathesis, that the mem- power of the nervous agency. It has been said that the brain branes of the cord were invaded by a translation of rheumatism. must, ;6f necessity, always contain the same quantity of blood,
many other organs, besides the but this does not apply to’every part of the nervous system, nor the course of rheumatic affections,is it, perhaps, altogether true of the brain; as Wilson Philip and it implication of the meninges of the remarks, there are several cavities in the skull, and the cerespine is too frequent and important not to claim’a separate bral tissue itself may admit of some degree of compressibility, so as to allow a certain augmentation in the quantity of its consideration. - In the cases of irritable spine, where great relief has beeni blood, however small it may be.* But, from whatever cause experienced from topical bleeding and blisters, there seems5 it may arise, anæmia is attended with a great derangement of reason to suppose that the nervous disorder is closely con-the nervous system-a state of excitement, coupled with an nected with one of the vascular system, and, in some cases,, exhaustion of power. The patient becomes anxious and resteven with sub-acute forms of inflammation. less, apprehensive of dissolution, the voice is lost, and delirium In the next place, I shall speak of the morbid associa-or convulsions supervene. The sensation we call faintness is, tions of the condition called anœmia, which are also veryno doubt, indicative of some change in the nervous system, important, but less numerous than those of inflammation,, and this is produced by large abstractions of blood. Andral because of the comparative infrequency of such disorder,, has spoken of anæmia of the brain; and, if we cannot deprive and because the system seems more gradually to adaptthe brain of its proper quantity of blood, we may at any rate itself to a deficiency of blood than to an irregular distri-deprive it of its due proportion of healthy blood, which is " bution of it. Anæmia (as well as many other conditionsvirtually the same thing. Though we cannot," says Dr. of disease) has been too little regarded in the explanation ofF Kelly, 11 buy general depletion entirely, or nearly, empty the pathological phenomena, and we are only now beginning to) vascular system of the brain, as we do the vessels of other arrive at a due estimation of many diseased actions, andparts of the body, it is yet possible, by profuse haemorrhage, to give an impartial distribution of our attention. Inflam-to drain it of a sensible portion of its red blood-that the place mation and irritation have been too long the only phrases inL of this spoliation seems to be supplied both by extra and intravascular serum, and that watery effusion within the head is a, our medical literature. The loss of blood not only diminishes the relative amount ofpretty constant concomitant, or consequence, of great santhe vital fluid in proportion to the solids of the body, but also guineous depletion."tjthe relative proportion of the constituents of the blood itself. The name, chlorosis, may be considered as a general expresMany of the effects produced by anaemia, may be ascribed tosion of some of the morbid associations of anaemia. An imchanges in the nature of the blood. It does not seem that all poverished state of the blood is the most frequent point of parts of the blood are reproduced with equal facility, so thatdeparture from which the disease originates; the imperfect any large demand on the vital fluid in reality occasions annutrition of the ovaries and uterine system generally, and alteration in its quality. The red particles appear to be only the diminished menstrual secretion, find their origin in this slowly’restored, and hence the long duration which elapsescause. One peculiarity of chlorosis, the green, or rather before those who havesuffered from extensive haemorrhagesyellowish--green colour, is probably, in a great measure, owing regain their natural complexion. We know that, with theto a disturbance of the hepatic functions, also connected with exception of menstruation, there is no natural secretion whichadepraved state of the blood. The manner in which the is supported at the expense of the red particles, and it may benervous system suffers in this complaint is also characteristic supposed that Nature cannot very easily restore what she is soof the ansemic state. Sydenham looked upon it as a form of careful of expending. If all the uses of the red particles in thehysteria, regarding more especially the nervous lesion which animal economy be not yet satisfactorily ascertained, there canis conjoined with it. Many of the associated conditions of be no doubt of their importance, and that a deficiency of themt anaemia are thus brought together and combined, so as to will be sensibly felt in every part of the system. Thus, re-constitute a complaint which most writers have regarded as garding the word, anfcmia, as expressive of a diminution in thesufficiently distinct to deserve a separate appellation. Probably in consequence of its effects on the nervous : System, healthy quantity of the blood, and an associated alteration inL its quality, it will be found to have important bearings onL when anæmia is rapidly induced, it is accompanied with a febrile action, which, though one of apparent strength, is, in many other pathological conditions. A state of ansemia is connected with a sensible alteration inreality, attended with great debility. This, which goes by the the tone and healthy nutrition of various structures in thename of luemorrhagic re-action, is a curious and unexpected body. A defective supply of blood is experienced as especiallyresult of the abstraction of blood. There is too much reason of this kind, accompanied, as they are, prejudicial during the growth of the body. In the female sex, to suppose that states a proper supply of blood to the ovaries is necessary for thewith throbbings in the head, increased sensibility, singing in evolution of puberty, and the nutrition of these parts seems tothe ears, and even delirium, have been confounded with, and have much influence on the general well-being of the system. treated as, inflammatory complaints; so common is it to The muscular tissue, particularly that of the heart, seemsimagine inflammation the only form of disease which is found also greatly dependent for its natural formation on a due pro- in combination with one of vascular excitement. The writings portion of healthy blood in the system. In those cases ofof Marshall Hall and others have done much to correct this dilatation of the heart which arise in a softening and attenua- vulgar and erroneous opinion. The connection of heterologous depositions with impoverished tion of its parietes, the complexion is indicative of a deficiency of blood; at the same time, it must be allowed that this states of the blood, and the low manifestations of vitality conon them, are interesting and important inquiries. ex-sanguineous appearance is further augmented by the en-’ sequent The ansemic state of the blood, the relations of which we have feebled force of the circulation. That antcmia should be productive of an embarrassment ofbeen describing, has, no doubt, important bearings on the deall those processes in which the blood-vessels are concerned velopment of tubercles; at the same time it cannot be regarded It is not always must appear so reasonable that it can excite no surprise that as a sufficient cause of their formation. the secerning actions are also greatly disturbed by it. A possible to unravel the web of communication which binds certain quantity of healthy blood is obviously necessary to together the elements of disease. That a diminution of the furnish the materials of support for the various functions globules of the blood is not, in itself, a sufficient cause of tuof the animal economy. The menstrual secretion becomes bercle, is rendered evident by the fact that, in chlorosis, where are reduced to their lowest quantity, the complaint greatly diminished, or altogether wanting, if the blood be the globules issues in phthisis, though I can largely impoverished. Thus, amenorrhcea is sometimes oc- by no means commonly with Andral, that tubercle does not casioned by a defective supply, as though the system could scarcely altogether agree not afford to give up the proper quantity of blood; at any more frequently invade the chlorotic than those who are not rate, the kind of blood which is generated in the anaemic the subjects of this complaint. The remarks of M. Andral on state ’is so far imperfect that the discharge is no longer the state of the blood in phthisis are replete with interest :" From the very commencement of pulmonary tuberculizacharacterized by its accustomed appearances. tion," says he, and when even auscultation can hardly detect Again, when we consider that the blood is the support of. its existence, the globules are already diminished; I have never nutrition, and, perhaps, more than :any other part connected in any with vitality itself; when we remember how generally it is seen them reach even their physiological average, 127, was 122, their case of the kind. Their highest representative, diffused, and how essential it is to every function of the body, it must be obvious that a deficiency of this fluid must be * Philip’s Experimental Inquiry, p. 271, 3d. edit. 1832. sensibly experienced by the nervous centres. There can be &dag er; Kelly on the Pathology of the Brain—Transactions of the Medicono doubt but that the nervous system suffers greatly by a loss Chirurgical Society of Edinburgh, 1828, part 1. no doubt but that are liable to suffer in seems to me that the
I make
heart,
’
I
I’
"
474
they -often v.aried between 120 and 100, ap- pressure of the cord, and I then detached it. Placing my proaching the latter number oftener than the former. The Mood’ hand on the abdomen I found the uterus well contracted down of persons, then, whose lungs are beginning to be tuberculous, into the pelvis. The placentae were then removed. The woman offers that particularmodification which belongs to feeble con- had previously given birth to eleven children, she is 41 years. stitutions ; they are truly ina state of commencing anaemia, of age; has a. very roomy pelvis, but saysall her children and their blood is.like that of patients who have been bled havebeen born small. The twins are somewhat less than tll several times."* this association is not, however, one of that average bulk and size, but not much; both cried lustily .and indispensable .kindwhich we regard as cause, and effect, but kicked vigorously at birth; they take their food well and, in full of meaning in respect to the " choice and application,’of short, are likely to thrive. The first born and the smallest of the modes of treatment." ; .two is a boy; the other, and larger, a girl. Finally, respecting many morbid associations, it is impossible October 15th.—Mother and children both doing well. to offer anything satisfactory, because the obscurity which prevails as to the nature of many diseases implies that we have no positive information in what manner their components CASE OF PLEURO-PERIPNEUMONIA. are associated or combined. Through what chain of derangement the extrinsic causes of disease operate in bringing about the malignant diseases, it is not possible to say precisely, By JAMES K. Dow, Esq., Surgeon, Downham-road, Islingtonl for though these affections are mostly united with low states ON the 8th May, at ten r.M., a friend of mine, a medica. of vitality and imperfect states of nutrition, and with anaemic called and requested me to accompany him to see, student, conditions of the blood, yet all these morbid elements may and to take upon myself the responsibility of, the following exist separately, without being necessarily accompanied with to which he a few hours previously had been called, and the establishment of such disorders. The same applies to the case, for which lie had prescribed. formation of cysts, hydatids, and the production of parasitical Elizabeth Fsingle woman, aged twenty-one, a shawl and growths, which are observed to attend low states of the system, parasol-fringer, went to her place of work that morning in her the for evolution their although precise conditions necessary usual of state good health: about 2 P.M., while at apparently are yet not properly understood. It is acknowledged that the she was suddenly seized with severe pain in her right common external influences’ of cold and moisture, and other work, home in a cab. ordinary agencies, in the production of disease, are, in them- side, and was forthwith brought left side; in reply to my found in her on the I bed, lying selves, insufficient to bring about such derangements; and it, therefore, remains for us still more attentively to analyze the questions, she complained of great pain in her right side, and morbid conditions which compose the malignant diseases, and placed her hand upon the space occupied by the sixth, seventh, observe the associations which connect them into a common and eighth ribs as its seat; she said there existed no pain elsewhere, and certainly there was no other place that exwhole. In the next paper, I shall pass on to a brief consideration ofhibited tenderness on pressure. On watching the respiratory the subject of the co-existence of morbid conditions; here con- action, it was so short and hurried, as to convey the- imprescluding what I have to say on the association of morbid action: sion of approaching suffocation; there was no cough. The not that I have by any means exhausted the subject, but it whole of the face, especially about the lips and beneath the would be tedious, if indeed it were possible, to anticipate all lower eyelids, was remarkably livid in its hue, and so the modes in which the processes of disease may be connected. puffed," as to warrant the conclusion that she had fared the Sufficient may have been said to show the importance of the worst in some recent pugilistic encounter. The pulse was subject, and to indicate in what manner the mind should frequent, small, quick, occasionally wiry, and intermittent. be directed to the observation of the relations of the more The tongue was furred, and rather moist. On percussing the elementary forms of disease. It then only remains to apply chest, there was much dulness in each of the regions ; on the same system of inquiry to any new series of combinations applying the stethescope, I at once detected the rhonchus which may present themselves. sonorous, sibilans, crepitans ; this last, the rule crepitant of We see that, independently of what are called extrinsic Laennec was present in a very marked degree. The heart causes of disease, the morbid changes, thereby produced, may palpitated with great force, and frequency ; the bruit de soufflet, was also very audible. Create further derangement by their alliance with each other. Broughton, near llancliester. While exploring these regions, the turgid state of the mammae, and their enlarged and darkened areolai, at once
lowest 99; and
.
"
of far-advanced
evinced a state pregnancy, and led me to look EXPULSION OF THE OVUM, ENTIRE, AT THE FULL for a corresponding swell, of a hemispherical form, hi the umbilical region, and in this I was not disappointed : strange PERIOD OF GESTATION. neither my patient, nor her relatives around, seemed By W. SYMONDS ROOTES, ESQ. M.D. ED., &c. ROSS, Herefordshire. however, to have the remotest consciousness, or idea of the existence of Tuis morning, 10th, at eight A.M.,I was requested to this °° hidden treasure." attend M. S——, the wife of a shoemaker of this town, in labour. Such were the pathognomic symptoms, and on the strength Visited her at ten; at eleven, the waters broke, and she went to of those derived from on the rhonchus auscultation, bed; on examination, found the head of the child presenting na- crepitans, I decided that this was a especially case of pleuro-peripneuhad and at cleared the brim of the pelvis, turally ; it half-past and that in the stage of congestion, the stage in which eleven the child was born in one pain, no arrest or delay occur- monia, curative measures were for the present most urgently and ring. After detaching the child,and before I had time to place my imperatively required. What was indicated ? The abstrachand on the patient’s abdomen, my attention was attracted by tion of blood until the approach of syncope : from this my a very strong pain-attracted to it by the nurse and the movefriend shrank, and thought that with such a weak pulse she ment of the patient, for throughout the whole of her labour could not bear bleeding. In these cases this is the usual she never gave utterance to a single cry or even moan. urged by young practitioners who havenot availed Thinking the placenta was coming away, I introduced a objection themselves of the benefits of auscultation, and as it is a most finger into the vagina by the side of the funis, and found the erroneous one as this and numberless other cases prove, I allude head of another child presenting very low down ; by its side, to it that it may be the more exposed, and more guarded partially over it, and likewise protruding through the vagina, against. After a little coaxing, and some force, I was allowed was a large bag of the membranes distended with water. This to open a vein, and abstracted about 12 ounces of blood : conI tried to rupture, but at the same moment a strong pain sequent upon this loss, the pleuritic pain considerably abated, came on, and the second child was born, enveloped ia the the dyspnoea was relieved, and the pulse at once became fuller: unbroken membranes, containing the liquor amnii, and with I moreover ordered that the right side of her chest, over the seat the placenta attached; the placenta of the first child, to the of should be unremittingly fomented ; that she should be pain, was all which the second placenta adherent, being margin of allowed but a little gruel and barley-water ; and prescribed the that remained in the vagina. I lifted up the bedclothes, and medicines :following showed the nurse this, to me, unique and beautiful sight; we of magnesia, 1 ounce ; tartarized antimony, R. Sulphate the the saw child, through transparent’ membranes, distinctly wine, 1½ drachm; tincture of digitalis, grain ; 1 & f r a c 1 2 ; ipecacuanha moving, as also the cord, which was coiled round its neck, and the divisions of the latter where it joined the placenta. I 1 drachm; distilled water, 6 ounces; for a mixture, 1 ounce to lost no time, however, in gazing on it, but proceeded to rup-be taken every three hours. R. Calomel, 12 grains; opium, 3 ture the membranes, and liberate the child’s neck from thegrains; extract of hyoscyamus, 15 grains; for eight pills, one every second hour. * 9th. 9, A. M.—On inquiry I found that the interval had beett Essay on the Blood in Disease. Translated by Meigs and Stillé, 1844.
October
I
ON
THE
ASSOCIATION
OF
INFLAMMATION
AND
of disease.
ANÆMIA WITH
stages of typhus fever, where the tongue has a, appearance, the skin assumes a dusky colour, for WHEN we spoke of inflammation we, of course, spoke of it ini the condition of the lining membrane of the bronchial tubes is the abstract; but its connection with other forms of diseasevery similar to that of the mouth and fauces, and such as to obviously depends much on its locality and intensity. A veryT interfere with the perfect arterialization of the blood. The common seat of inflammation is the lining membrane of thelate Dr. Armstrong, who devoted much of his attention to the bronchial tubes; and it is apparent that when inflammation1 subject of fever, regarded this peculiarity of the bronchial exists in this situation, it must interfere materially with the; membrane, in the advanced stage of typhus, as very intimately proper arterialization of the blood. In this manner, bronchitis,, connected with the manifestations of the complaint in many of when of long continuance, greatly prejudices the healthyr its phases. I am much inclined to agree with him in supquality of the blood, and produces, or at any rate, favours, thatt posing that the coma and insensibility of fever are often much state of depression and debility which accompanies many of the; aggravated, if not, indeed, produced, by the existence of an auctions of old age. The coldness and lividity, as well as the: especial affection of the bronchial tubes. ’’ The bronchial cerebral confusion which also attends such diseases, are, in like lining," says he, 11 is invariably found highly-congested with dark blood; and a sticky secretion, which besmears the memmanner, traceable to the vitiated state of the circulation. The dependence ofa deranged state of the blood on thea brane, exercises a most important influence over the pathology presence of inflammation is further evident in many of the3 of the affection, by changing the constitution of the blood in a eruptive diseases. In the complaint called measles, for ex-way which I have already explained. If the sticky varnish be ample, a specific poison operates on the system, which appears,, washed off with a sponge, the membrane exposed to the air amongst other effects, to produce an inflammatory condition1 soon becomes vividly red." of the mucous membranes. The mucous surface of the bronchial1 Another morbid association which inflammation acquires tubes is especially implicated, and, partly owing to theinflu-from its particular position is that of an implication of’ the 8 nervous ence of the febrile poison on the blood, but chiefly to the system. Many of the complaints called neuralgic are, existence of bronchial inflammation, the healthy changes in thein reality, of a mixed character, and owemuch of their severity lungs are imperfectly carried on. We find, therefore, thee to inter-current attacks of an inflammatory nature. It would accompanying eruption characterized by this improperly de-- lead us into considerable practical error to look upon hysteric carbonized state of the blood. The lips and cheeks are of aEL affections as altogether unconnected with inflammations and dusky hue, and the rash of a dingy-red or purple tint. Thee congestions; for though they may be entirely free from brain, also, suffers more or less, and hence the state of stuporr such complications, it is also quite possible that some of and want of energy which commonly indicate the affection.,- the symptoms, called nervous, areabsolutely due to these The production of nervous agency, and even of vitality itself, lesions. I have had reason to suspect, in certain obscure casesIn
OTHER CONDITIONS OF DISEASE.
seem
greatly dependent
nor can
it be
a
on
the presence of
some
glazed dry
healthy blood;
matter of wonder that this condition should be
productive of considerable debility. It thus happens that, -in
*
Stokes
on
the Chest,
&dag er; Lectures by Rix,
p.
93.
p. 564.
473 spinal disorder, attended with painful spasmodic action,, of blood, and probably there is a consequent diminution in the occurring in persons of a rheumatic diathesis, that the mem- power of the nervous agency. It has been said that the brain branes of the cord were invaded by a translation of rheumatism. must, ;6f necessity, always contain the same quantity of blood,
many other organs, besides the but this does not apply to’every part of the nervous system, nor the course of rheumatic affections,is it, perhaps, altogether true of the brain; as Wilson Philip and it implication of the meninges of the remarks, there are several cavities in the skull, and the cerespine is too frequent and important not to claim’a separate bral tissue itself may admit of some degree of compressibility, so as to allow a certain augmentation in the quantity of its consideration. - In the cases of irritable spine, where great relief has beeni blood, however small it may be.* But, from whatever cause experienced from topical bleeding and blisters, there seems5 it may arise, anæmia is attended with a great derangement of reason to suppose that the nervous disorder is closely con-the nervous system-a state of excitement, coupled with an nected with one of the vascular system, and, in some cases,, exhaustion of power. The patient becomes anxious and resteven with sub-acute forms of inflammation. less, apprehensive of dissolution, the voice is lost, and delirium In the next place, I shall speak of the morbid associa-or convulsions supervene. The sensation we call faintness is, tions of the condition called anœmia, which are also veryno doubt, indicative of some change in the nervous system, important, but less numerous than those of inflammation,, and this is produced by large abstractions of blood. Andral because of the comparative infrequency of such disorder,, has spoken of anæmia of the brain; and, if we cannot deprive and because the system seems more gradually to adaptthe brain of its proper quantity of blood, we may at any rate itself to a deficiency of blood than to an irregular distri-deprive it of its due proportion of healthy blood, which is " bution of it. Anæmia (as well as many other conditionsvirtually the same thing. Though we cannot," says Dr. of disease) has been too little regarded in the explanation ofF Kelly, 11 buy general depletion entirely, or nearly, empty the pathological phenomena, and we are only now beginning to) vascular system of the brain, as we do the vessels of other arrive at a due estimation of many diseased actions, andparts of the body, it is yet possible, by profuse haemorrhage, to give an impartial distribution of our attention. Inflam-to drain it of a sensible portion of its red blood-that the place mation and irritation have been too long the only phrases inL of this spoliation seems to be supplied both by extra and intravascular serum, and that watery effusion within the head is a, our medical literature. The loss of blood not only diminishes the relative amount ofpretty constant concomitant, or consequence, of great santhe vital fluid in proportion to the solids of the body, but also guineous depletion."tjthe relative proportion of the constituents of the blood itself. The name, chlorosis, may be considered as a general expresMany of the effects produced by anaemia, may be ascribed tosion of some of the morbid associations of anaemia. An imchanges in the nature of the blood. It does not seem that all poverished state of the blood is the most frequent point of parts of the blood are reproduced with equal facility, so thatdeparture from which the disease originates; the imperfect any large demand on the vital fluid in reality occasions annutrition of the ovaries and uterine system generally, and alteration in its quality. The red particles appear to be only the diminished menstrual secretion, find their origin in this slowly’restored, and hence the long duration which elapsescause. One peculiarity of chlorosis, the green, or rather before those who havesuffered from extensive haemorrhagesyellowish--green colour, is probably, in a great measure, owing regain their natural complexion. We know that, with theto a disturbance of the hepatic functions, also connected with exception of menstruation, there is no natural secretion whichadepraved state of the blood. The manner in which the is supported at the expense of the red particles, and it may benervous system suffers in this complaint is also characteristic supposed that Nature cannot very easily restore what she is soof the ansemic state. Sydenham looked upon it as a form of careful of expending. If all the uses of the red particles in thehysteria, regarding more especially the nervous lesion which animal economy be not yet satisfactorily ascertained, there canis conjoined with it. Many of the associated conditions of be no doubt of their importance, and that a deficiency of themt anaemia are thus brought together and combined, so as to will be sensibly felt in every part of the system. Thus, re-constitute a complaint which most writers have regarded as garding the word, anfcmia, as expressive of a diminution in thesufficiently distinct to deserve a separate appellation. Probably in consequence of its effects on the nervous : System, healthy quantity of the blood, and an associated alteration inL its quality, it will be found to have important bearings onL when anæmia is rapidly induced, it is accompanied with a febrile action, which, though one of apparent strength, is, in many other pathological conditions. A state of ansemia is connected with a sensible alteration inreality, attended with great debility. This, which goes by the the tone and healthy nutrition of various structures in thename of luemorrhagic re-action, is a curious and unexpected body. A defective supply of blood is experienced as especiallyresult of the abstraction of blood. There is too much reason of this kind, accompanied, as they are, prejudicial during the growth of the body. In the female sex, to suppose that states a proper supply of blood to the ovaries is necessary for thewith throbbings in the head, increased sensibility, singing in evolution of puberty, and the nutrition of these parts seems tothe ears, and even delirium, have been confounded with, and have much influence on the general well-being of the system. treated as, inflammatory complaints; so common is it to The muscular tissue, particularly that of the heart, seemsimagine inflammation the only form of disease which is found also greatly dependent for its natural formation on a due pro- in combination with one of vascular excitement. The writings portion of healthy blood in the system. In those cases ofof Marshall Hall and others have done much to correct this dilatation of the heart which arise in a softening and attenua- vulgar and erroneous opinion. The connection of heterologous depositions with impoverished tion of its parietes, the complexion is indicative of a deficiency of blood; at the same time, it must be allowed that this states of the blood, and the low manifestations of vitality conon them, are interesting and important inquiries. ex-sanguineous appearance is further augmented by the en-’ sequent The ansemic state of the blood, the relations of which we have feebled force of the circulation. That antcmia should be productive of an embarrassment ofbeen describing, has, no doubt, important bearings on the deall those processes in which the blood-vessels are concerned velopment of tubercles; at the same time it cannot be regarded It is not always must appear so reasonable that it can excite no surprise that as a sufficient cause of their formation. the secerning actions are also greatly disturbed by it. A possible to unravel the web of communication which binds certain quantity of healthy blood is obviously necessary to together the elements of disease. That a diminution of the furnish the materials of support for the various functions globules of the blood is not, in itself, a sufficient cause of tuof the animal economy. The menstrual secretion becomes bercle, is rendered evident by the fact that, in chlorosis, where are reduced to their lowest quantity, the complaint greatly diminished, or altogether wanting, if the blood be the globules issues in phthisis, though I can largely impoverished. Thus, amenorrhcea is sometimes oc- by no means commonly with Andral, that tubercle does not casioned by a defective supply, as though the system could scarcely altogether agree not afford to give up the proper quantity of blood; at any more frequently invade the chlorotic than those who are not rate, the kind of blood which is generated in the anaemic the subjects of this complaint. The remarks of M. Andral on state ’is so far imperfect that the discharge is no longer the state of the blood in phthisis are replete with interest :" From the very commencement of pulmonary tuberculizacharacterized by its accustomed appearances. tion," says he, and when even auscultation can hardly detect Again, when we consider that the blood is the support of. its existence, the globules are already diminished; I have never nutrition, and, perhaps, more than :any other part connected in any with vitality itself; when we remember how generally it is seen them reach even their physiological average, 127, was 122, their case of the kind. Their highest representative, diffused, and how essential it is to every function of the body, it must be obvious that a deficiency of this fluid must be * Philip’s Experimental Inquiry, p. 271, 3d. edit. 1832. sensibly experienced by the nervous centres. There can be &dag er; Kelly on the Pathology of the Brain—Transactions of the Medicono doubt but that the nervous system suffers greatly by a loss Chirurgical Society of Edinburgh, 1828, part 1. no doubt but that are liable to suffer in seems to me that the
I make
heart,
’
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I’
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474
they -often v.aried between 120 and 100, ap- pressure of the cord, and I then detached it. Placing my proaching the latter number oftener than the former. The Mood’ hand on the abdomen I found the uterus well contracted down of persons, then, whose lungs are beginning to be tuberculous, into the pelvis. The placentae were then removed. The woman offers that particularmodification which belongs to feeble con- had previously given birth to eleven children, she is 41 years. stitutions ; they are truly ina state of commencing anaemia, of age; has a. very roomy pelvis, but saysall her children and their blood is.like that of patients who have been bled havebeen born small. The twins are somewhat less than tll several times."* this association is not, however, one of that average bulk and size, but not much; both cried lustily .and indispensable .kindwhich we regard as cause, and effect, but kicked vigorously at birth; they take their food well and, in full of meaning in respect to the " choice and application,’of short, are likely to thrive. The first born and the smallest of the modes of treatment." ; .two is a boy; the other, and larger, a girl. Finally, respecting many morbid associations, it is impossible October 15th.—Mother and children both doing well. to offer anything satisfactory, because the obscurity which prevails as to the nature of many diseases implies that we have no positive information in what manner their components CASE OF PLEURO-PERIPNEUMONIA. are associated or combined. Through what chain of derangement the extrinsic causes of disease operate in bringing about the malignant diseases, it is not possible to say precisely, By JAMES K. Dow, Esq., Surgeon, Downham-road, Islingtonl for though these affections are mostly united with low states ON the 8th May, at ten r.M., a friend of mine, a medica. of vitality and imperfect states of nutrition, and with anaemic called and requested me to accompany him to see, student, conditions of the blood, yet all these morbid elements may and to take upon myself the responsibility of, the following exist separately, without being necessarily accompanied with to which he a few hours previously had been called, and the establishment of such disorders. The same applies to the case, for which lie had prescribed. formation of cysts, hydatids, and the production of parasitical Elizabeth Fsingle woman, aged twenty-one, a shawl and growths, which are observed to attend low states of the system, parasol-fringer, went to her place of work that morning in her the for evolution their although precise conditions necessary usual of state good health: about 2 P.M., while at apparently are yet not properly understood. It is acknowledged that the she was suddenly seized with severe pain in her right common external influences’ of cold and moisture, and other work, home in a cab. ordinary agencies, in the production of disease, are, in them- side, and was forthwith brought left side; in reply to my found in her on the I bed, lying selves, insufficient to bring about such derangements; and it, therefore, remains for us still more attentively to analyze the questions, she complained of great pain in her right side, and morbid conditions which compose the malignant diseases, and placed her hand upon the space occupied by the sixth, seventh, observe the associations which connect them into a common and eighth ribs as its seat; she said there existed no pain elsewhere, and certainly there was no other place that exwhole. In the next paper, I shall pass on to a brief consideration ofhibited tenderness on pressure. On watching the respiratory the subject of the co-existence of morbid conditions; here con- action, it was so short and hurried, as to convey the- imprescluding what I have to say on the association of morbid action: sion of approaching suffocation; there was no cough. The not that I have by any means exhausted the subject, but it whole of the face, especially about the lips and beneath the would be tedious, if indeed it were possible, to anticipate all lower eyelids, was remarkably livid in its hue, and so the modes in which the processes of disease may be connected. puffed," as to warrant the conclusion that she had fared the Sufficient may have been said to show the importance of the worst in some recent pugilistic encounter. The pulse was subject, and to indicate in what manner the mind should frequent, small, quick, occasionally wiry, and intermittent. be directed to the observation of the relations of the more The tongue was furred, and rather moist. On percussing the elementary forms of disease. It then only remains to apply chest, there was much dulness in each of the regions ; on the same system of inquiry to any new series of combinations applying the stethescope, I at once detected the rhonchus which may present themselves. sonorous, sibilans, crepitans ; this last, the rule crepitant of We see that, independently of what are called extrinsic Laennec was present in a very marked degree. The heart causes of disease, the morbid changes, thereby produced, may palpitated with great force, and frequency ; the bruit de soufflet, was also very audible. Create further derangement by their alliance with each other. Broughton, near llancliester. While exploring these regions, the turgid state of the mammae, and their enlarged and darkened areolai, at once
lowest 99; and
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of far-advanced
evinced a state pregnancy, and led me to look EXPULSION OF THE OVUM, ENTIRE, AT THE FULL for a corresponding swell, of a hemispherical form, hi the umbilical region, and in this I was not disappointed : strange PERIOD OF GESTATION. neither my patient, nor her relatives around, seemed By W. SYMONDS ROOTES, ESQ. M.D. ED., &c. ROSS, Herefordshire. however, to have the remotest consciousness, or idea of the existence of Tuis morning, 10th, at eight A.M.,I was requested to this °° hidden treasure." attend M. S——, the wife of a shoemaker of this town, in labour. Such were the pathognomic symptoms, and on the strength Visited her at ten; at eleven, the waters broke, and she went to of those derived from on the rhonchus auscultation, bed; on examination, found the head of the child presenting na- crepitans, I decided that this was a especially case of pleuro-peripneuhad and at cleared the brim of the pelvis, turally ; it half-past and that in the stage of congestion, the stage in which eleven the child was born in one pain, no arrest or delay occur- monia, curative measures were for the present most urgently and ring. After detaching the child,and before I had time to place my imperatively required. What was indicated ? The abstrachand on the patient’s abdomen, my attention was attracted by tion of blood until the approach of syncope : from this my a very strong pain-attracted to it by the nurse and the movefriend shrank, and thought that with such a weak pulse she ment of the patient, for throughout the whole of her labour could not bear bleeding. In these cases this is the usual she never gave utterance to a single cry or even moan. urged by young practitioners who havenot availed Thinking the placenta was coming away, I introduced a objection themselves of the benefits of auscultation, and as it is a most finger into the vagina by the side of the funis, and found the erroneous one as this and numberless other cases prove, I allude head of another child presenting very low down ; by its side, to it that it may be the more exposed, and more guarded partially over it, and likewise protruding through the vagina, against. After a little coaxing, and some force, I was allowed was a large bag of the membranes distended with water. This to open a vein, and abstracted about 12 ounces of blood : conI tried to rupture, but at the same moment a strong pain sequent upon this loss, the pleuritic pain considerably abated, came on, and the second child was born, enveloped ia the the dyspnoea was relieved, and the pulse at once became fuller: unbroken membranes, containing the liquor amnii, and with I moreover ordered that the right side of her chest, over the seat the placenta attached; the placenta of the first child, to the of should be unremittingly fomented ; that she should be pain, was all which the second placenta adherent, being margin of allowed but a little gruel and barley-water ; and prescribed the that remained in the vagina. I lifted up the bedclothes, and medicines :following showed the nurse this, to me, unique and beautiful sight; we of magnesia, 1 ounce ; tartarized antimony, R. Sulphate the the saw child, through transparent’ membranes, distinctly wine, 1½ drachm; tincture of digitalis, grain ; 1 & f r a c 1 2 ; ipecacuanha moving, as also the cord, which was coiled round its neck, and the divisions of the latter where it joined the placenta. I 1 drachm; distilled water, 6 ounces; for a mixture, 1 ounce to lost no time, however, in gazing on it, but proceeded to rup-be taken every three hours. R. Calomel, 12 grains; opium, 3 ture the membranes, and liberate the child’s neck from thegrains; extract of hyoscyamus, 15 grains; for eight pills, one every second hour. * 9th. 9, A. M.—On inquiry I found that the interval had beett Essay on the Blood in Disease. Translated by Meigs and Stillé, 1844.
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