REVIEWS FROM THE WEST.

423 remedies ; and after death, the appear-

REVIEWS FROM THE WEST.

ances

I

upon dissection.

At the dissection

always accompanied by one, two or three medical gentlemen ; and it was my uniform practice to take down in writing, was

An account of the Morbid Appearances at the time, the account of the morbid exhibited on dissection, in various disor- changes from the lips of the examining this account, on my return ders of the Brain; with Pathological surgeonI ; into my note book, and, home, copied of then, the whole case being clearly before Observations, to which a Comparison of Morbid Changes me, and my mind full on the subject, I the Symptoms with the Morbid THOMAS MILLS, wrote down the sentiments to which it has given rise.-By rise.—By THQMAS gave birth." M.D. Dublin. J. Cumming, M.D.Dublin. Cnmming, and Hodges and M’Arthur, and Longman & Co. Now, reader, is not this a truly edifying account of the process of

London, 1826.

generating

a

book? Only just observe the systematic Tnfmedical press of Dublin is a lady of with which the deed was perthe most exemplary continence. Except accuracy indeed that she

now

and then

noted down the sympcoquettes I petrated ; first,

effects of the remedies ; with a quack, or yields to the solicitation I toms ; next, the with witnesses, the of some young professional gallant, she then, being provided on dissection; be presented included hie vel appearances might well among the out the whole into a hœe entities of the epicene gender. Be- afterwards, copied and with his at note book, home, too; sides these profligate authors of puffs and pamphlets, and the occasional tyro just mind full of the subject, wrote down the clothed in the toga virilis of a license, sentiments to which it gave biitli. And we believe this is the usual course cager to try the virility of his genius,i yet her ladyship has few established fa- followed in the manufacture of a volume, vourites in the city, on whom she periodi- though one would realiy suppose, from the cally confers the honour of literary pa- punctuated conciseness and serious manrelitage, Amongst these prurient ad- uer with which Mr. Mills propounds the mirers of her cliarnis, Mr. Mills holds a matter, that there was something peculiar his method of bringing an octavo into very high place in her affection, aud has the world. We can assure him, however, made her aa mother the greatest number that there is nothing uncommon in hisof times; the production with the queer name at the top of the page, being, we mode of literary procreation, except inbelieve, the seventh offspring with which deed the superfluous simplicity of obliging it has pleased heaven to bless the nup- us with a secret, " lippis et tonsoribus tials of this fond couple. The amour, ot notum."

in

This specimen we hope will satisfy the which the present work is the result, has been going on for no less than sixteen curious about the " Introduction ;" bewith a years, as the good man informs us, so that sides which we are favoured " of life ns we for the we might expect nothing short of a Her- Preface," though this inin cales from such a protracted gestation. cannot divine any reason why, " permit papa himself to in- stance, two birds might not have been striiet us with the history of the transac- killed with one stone." The latter gravely

But we

must

tion; "About sixteen years ago I began to

bespeaks our "

Several

attention thus :

cases

and dissections are here

investigate the source of disease, and the detailed of hydrocephalus, cephalic fever, cause of symptoms through the medium apoplexy and epilepsy. These are conof morbid anatomy. My plan was, to ered distinct and independent diseases, note the

symptoms, and the effects of the

requiring

a

distinct and peculiar mode of

424

treatment;yet when we attentively ex- dependent, requiring a distinct and pecnamine the phenomena and course of each, liar mode of treatment." when

compare them, one with anowitness the morbid appearances exhibited in all, and the effects of the same remedies, we shall be compelled to acknowledge that these diseases are closely allied, and, in the true spirit ofphitosophical research, be disposed to allow that the morbid actions, which produce effects so alike, cannot in their nature be dissimilal’. In regard to these disordered actions, various modifications must occur, proceeding from the intensity and variety of the cause ; the constitution, age, sex, previous habits and diseases of the patient, the condition of the atmosphere, and other incidental circumstances. It is a remarkable fact that these diseases pass and repass one into the other: epilepsy, for example, often terminates in apoplexy, and apoplexy in epilepsy. Cephalic, or typhus fever, sometimes passes into apoplexy, sometimes into epilepsy, we

ther, and

but,

most

frequently

into

hydrocephalus ;

As

we

disease,

live, Mills, and

there is bnt

thou art its

one

prophet!-

old tnne of pa. over thological identity again, with new words and accompaniments. The chemists threw the world into an alembic, and found it to consist of only caruon, hydrogen and oxygen; Mr. Mills byano. ther analytical short cut, has discovered that all the phenomena of cerebral dis. oders are referrible to the agency of a something, which he calls a " morbid action." When this little fiend makes his way into a man’s head, no matter how, when, or where, it is a mere chance and not all to the point, whether he amuses himself by opening a blood-vessel, var. nishing the hemispheres with purulent matter, spilling a few ounces of serous fluid into the ventricles, or gluing up the membranes with a cement of coagulahle lymph. At one time we find him keeping Here

we

have the

same

and hydrocephalus is often accompanied in its progress by an apoplectic or epileptic paroxysm. The phenomena of these diseases likewise merit the serions attention of the reader; in each he finds the prominent symptoms to be headache, delirium, stupor, coma, sense of weight, or fatness of the head, vprtigo, tinitus aurittm, convulsions, paralysis of a man forty years a maniac ; at another, sphircters and other muscles, all which actions of are indicative of disnrdfred killing him without a moment’s warning; the vascular system of the brain, and of a or now and then tripping up his heels in disturbance ot the sensorial functions. To these symptoms we may add a pulse a fit of epilepsy ;or drowning life with a varying in strength, frequency and irre- deluge of hydrocephalic water. Opinia gularity, a varying temperature of the transformat sese in miracula rerum; in skin, and an irregular state of the seci etions. To these remarkable circumstances short, this mischievous elf is a perfect I shall subjoin the appearances most com- Proteus, and not unlikely may have afflict. monly discovered in the brain on dissec- ed our author with the malady of writing tion, - viz. effusion of serum, coagtilable lymph or blood, thickening of the mem- this singular book. But to be serious; branes,rupture of blood vessels or for- our readers may recollect that we some mation of purulent matter. Nor can we pass over in silence the remedies usually time ago noticed a desperate attempt employed, with a view to the cure of these made by Mr. Mills to deprive no less than disorders, which consist, for the most a dozen or so of diseases of independent part in bloodletting, general and topical ; in blistering ; in the exhibition of aperi. existeuce, and he is now about to dispose ents, mercurials, antimollials and sudo- of three or four others in the same comrifics, and in the use of counter-stimu. lants. Further, in regard to their pre- pendious manner. We then ventured to vention, we find all practitioners agreed inform him in other words thatsimilitude, as to the propriety of adopting the same however perfect the resemblance may be, regimen, and of adopting one or more drain from the head or in its vicinity. I does not constitute identity, no more than now beg leave to submit these matters we could be Dr. Mills though we might the consideration of the reader, and then be as like each other as two quaker hats; I would ask, can these disorders of the brain be looked upon as distinct and in- that the same medicines having cured two

the

!

toi

425

them complaints sompiaints dodo not notmake makethem

s

one, no portion of the frontal bone and the nasal bone, through which a protrusion of the same lead the silver and are mrethan cortical substance of the brain occurred, metals from being smelted out of one and formed a tumour externally of the

This tumour was by the same fire ; and that diasec- size ot’ a gooseberry. a morbid growth of the cortical by tion, though often presenting a similar substance of the brain, and was covered stateof parts in different disorders, not with the arachnoid membrane, the pia and a prolongation of the dura only did not prove these disorders to be mater, mater; it existed from the birth of the thesame, but that dissection in many child ; was removeable by pressure ; cases showed nothing at all that we can would disappear on yawning, and be or coughunderstand. If, indeed, as Mr. Mills violently protruded by crying ing. would have us believe, we saw postComment.-rr Was the protrusion of the in this instance, owing to a morbid mortem appearances preceded even by brain, of its cortical substance, which growth symptoms nearly alike in those diseases prevented the formation of bony matter ? of which he treats, we should willingly or did it proceed simply from a wantofsups mass

,

’,

I formed

in consequence of defective ossificaaccede to his conclusion that " morbid port, tion ? Different opinions of the nature of actions which produce effects so alike, the tumour, were entertained by different practitioners ; by one, the disease was deeanuot, in their nature be dissimilar;" but nominated napvi materni; by another it we have never observed the regularity was considered as a watery cotlection ; of cause and effect discoverable in his by a third, as a fungous or fatty matter ; dissections. In fact we thilik less infor- and by a fourth, a portion ot the brain itself. The dissections proved, that it mation is to be attained of the " cause" consisted of the cortical substance; comof disease from this Hebraic system ofpression by means of an elastic steel infor the removal strument, was reading its course backwards by anatomy, of this tumour;employed on applying which, it than most persons imagine, though per- was often observed, that the child, though before lively, sunk into a hapsit is the only plan left us to follow. immediately state of stupor. May not the propriety We shall now lay a few of Mr. Mills’s of the practice be therefore questioned ? casesbefore the leader. May not the pressure have deranged the circulation ot the brain, causing exciteand conjestion of its vessels, thereCaseof Hydrocephalus, with a protrusion ment rise to serous efftisioii into the by giving Brain. the of ventr icles, which was the cause of death."

"Master R., aet. nine months, labours nnder the following symptoms-uneasiness and fretfulness ; frequent moaning and

sighing; retching

and

vomiting ;

Case of Hydrocephalus, with Inflammation the

of Alimentary Canal, accompanied tossing of the hands and arms ; diminished by (in extraordinary lusus naturœ;the appetite; stupor occasionally; irregular want of an Hepatic Artery, fever; irregular state of the bowels ; wastini; of flesh; convnlsions. Fr om the °‘ On the 16th of April, 1822, I was birth of this child, a tumonr of the sizecalled on to visit an infant child. seven of a small gooseberry has existed imme- days old, of Mr. G--’s, Upper Gardener diately below the os frontis, which occa- Street, where I met Dr. Douglas in consionally appears and disappears. Deathisultation :-the skin and the tunica conon the 8th March, after a trial of thejunctiva of the eye, had a jaundiced apnsual remedies. pearance ; the pulse was feeble, frequent

Dissection.-Dura mater remarkablyand irregular; there was frequent openadherent to the internal cranium. Fon-ing and shutting of the mouth ; there was tanelle.ossification, very deficient. Serouscoma and vomiting : the faeces were fluid effusion between the arachnoid membraneand of a light yellow, and pain was ex. and pia mater. Venons turgescence inicited on pressing the abdomen. Dill ing the vessels of the surface of the brain.the night of the 16th, the child died ; Lateral ventricles rontain about two) when born it was liilly formed, and had a oances of watery fluid. Plexus choroides,healthy look; it was spoon-fed. Conhighly vascular. There is an aperture ojf siderable emaciation took place on the the size of a sixpence between the lowetr 5th and Gth days after birth, when tt be-

426

fretful and heavy, and vomited itss 21, Blood slightly buffed and dense! food." temporary ease from the blepding; deDissection.-" Liver of a dark colour., lirium ; restlessness; f2eces greenish and harder and smaller than natural : it iss yellow ; urine, turbid ; pulse 130, hard; adherent to the peritoneum lining thes affection of the head still violent, parietes of the abdomen, by very minute’ Hirxd. xx. temp. Cr.med. Oct.22,llead filaments. Gall-bladder seems imbed-- relieved for a few hours, by the leeches; ded in the liver, and so sm,all, that itt symptoms as violent as yesterday; wild came

,

Oct.

would not contain a drachm of any kind off’ expression of countenance; Vesiecapit, fluid ; it is in part filled with a substancee abras. V. s. zviij. Cr. med. Oct. 23, resembling meconium. Peritoneum part-- Moaning, screammg, acnte head-ache, ly transparent, and partly of a vermilioni alternate paleness and flushing of the colour. Stomach, internally and ex-- face, skin hot, and partially moist, fmces ternally, exceedingly vascular; in som-egreenish, and at times passed iiivoltin. places of a dark colour, in others of a. tarily, belly soft. Hirud. xv. tem. Cr, dark red. Intestines ; their externalIcal. et pnlv. Jacob. Ell. purg. Oct24, coat has the same appearance as that off No alleviation of the symptoms: pupil of the stomach, but their internal is whitishthe left eye contracted, that of the right and natural. Heart and lungs sound.dilated, but both sensible to light. The scalp and the surface of the brain Vesic. front. Cr. med. Oct. 25, Pulse exhibit ahigh degree of vascularity; by ac- irregular, tense and frequent; skin,.somecident the meninges and ventricles were what cool and constrictred ; moaning aod laid open, and the quantity of fluid con- screaming, I Oh ! my head!"involuntained could not be ascertained ; but at tary dejection;!. Cr med. October 16, the base of the brain, about an ounce ofHigh delirium, restlessness, skin hot and watery fluid was detected of a bloody dry ; sight of left eye apparently lost, colour. The hepatic artery was want- pupil of right eye dilated, yet sensible to light, pnlse slow and intermitting; moan. ing." Comment.-" This is an extraordinary ing and sighing; involuntary dejections,

convulsions of the extremities. Hirud. xvj. temp. Vesic. Nuchae. Con. pulv.Jacob, et cal. - Oct. 28, Deglutition difficult, in. voluntary dejections, tossing and rolling of the head, pulse frequent, loq of the power of speech. En. purg. P. Jacob. cum. p. rhei. Oct. 29, Nearly asyester day, pulse feeble and intermitting, occasionally a little of James’s Powder and is swallowed. Oct. 31, No alteration of the symptoms. Cr. p. Jacob. et p. rhei. Nov. 3, Considerable flow of urine, temperature of the skin more equable, expression of countenance at one time wild, at another idiotic, speech inliver." distinct. Nov. 6, Some alleviation of the An extraordinary case of recovery from symptoms, faeces yellowish and green, Irille in large quantity, pulse more reacute Hydrocephalus. gniar and soft, pupils more sensibleto Master E-, aetat. 9, a fortnight light. Cr. p. Jacob. et p. rhei. Nov. 10, ago, without any cause, complained of Some return of rest, sighing, moaning head-ache, nausea, and a diminution of’ and screaming diminishing, skin soft, appetite, followed by alternate chidlness takes a little tood. Cr. med. Nov. 18, and heat, and accompanied by a frequent Expression of countenance still idiotic, varying pulse, a foul tongue, thirst and gradual restoration of sight, seems to restlessness. Leeches have been applied! suffer much from mortification of one of to the temples, and calomel, aperients, the hips. Nov. 21, Speech still indistinct. the saline juiep, and blisters have beep Cr. med. Nov. 30, Speech and vision employed without affording any relief more distinct, gradual amendment, irriThe pain of the head is now acute, the tation from a foul ulcer on the back and temples throb; the face is flushed, and hip. Dec. 10, Weak and delicate, both the eyes are suffused. Pulse 121, and in mind and body. Dec. 21, Better in strong ; skin hot and dry ; tongue foul ; every respect. 1815. Jan. 12, Is still bowels free; faeces of a greenish yellow; confined to bed by the sores, but thereis urine high coloured; V. S. zviij. Cal. et an evident amendment both of body and pulv. Jacob. Mist. cathart. En. purg. mind." lus us naturœ; I have never witnessed a second instance of this kind. The gallbladder was filled with a substance resembling meconmm ; the liver was turgid with blood, and yellowish ; the f2eces were of a light yellow ; a secretion of bile may therefore take place, independently of It is scarcely an hepatic artery. - - necessary to state that the morbid appearances here enumerated sufficiently account for the phenomena, and the death of the patient. To the want of the hepatic artery may be ascribed the dark colour and diminished size of the

rhubarb

427

Oar space does not permit

in-

style, and mysterious punctuation, ob. dulge in further quotation, except to pre- servable in thy pages, tend to confirm sent the reader with the following corol. what we advanced respecting thy late ns to

perusal of the above authors, whose ’ dred pages of cases, commentaries and faults thou dost mimic so abominably ? Mr. Mills: why should the ef. dissections. Any thing, in the way fusion of blood, pus,serum, or coagulable medical reports, more slovenly to or more lymph be set down to the operation of ted, more silly as observation, inconclusive in argument, we never read the same caase ? for then what becomes " that similar causes prothan these di!jointed paragraphs, or lit- of the axiom, tle islands of print, floating in an ocean duce similar results," since in this inwe have effects of the most conlory jedoced from upwards of

two

hun-

execu-ofFudge!

of margin.

thestance tradictory

nature produced too, as you moibidchanges observed in these dissec- tell us, by one and the same cause ? tions, tends to confirm what has been Take that state of a part which generates advanced respecting the similarity of diseases, of which these changes have pus, for example, and are you prepared been the result; for it’in the phenomena to say that this part is in the same conofinaiiimated nature, connexion between You catise and effect is so close that we argue dition, as when it effuses serum ? an identity of cause from observing an hint indeed, pretty plainly, that your identity of effect, shall not the same I" is inflammation, and cause" of i disease, mode of argument be applicable, as we rise in the scale of creation, from the in- that the phenomena enumerated are well animate to the animated world ? Shall known to be its terminations; but we

Conclusion.-" The similarity of

the linksof the great chain which binds and effect be here rent asunder? have seen, time. without

number, pus, they serum, coagulable lymph, and adhesion become,if possible, bound more closely produced when there was neither pain, sim together? that the same heat, redness, swelling nor any other plicity remains, and that, where the same effects are produced, we present by which inflammation are authorized in conclnding that the known to exist. When a case, of whatsame causes produce them ? " ever kind, ceases to be unerring in its Miglrty master of the comma, hyphen, one would think there must be operation, and note of interrogation ! hast then some alteration to account for the change been lately in the mists of the hill" with Ossian, strutting through the de- of the product. Yet Mr. Mills imagined clamations of Goldsmith’s " animated," that his fabric was founded upon the and St.pierre’s" Harmonies," of nature; converse of this proposition, though it is lie did not understand its tenor, on a rhetorical incursion through theevident raase

or, rather, shall

we

not suppose that

admirable therefore,

I ischaracter

tomes of Sterne? for if in

to demolish his system. the phenomenadency he favours particular own

information,

of writing with a goose-quill and infusion

us

For

with

and a " morbid action" of unlimited operaof galls, and forces his way to a conclusion, effect is so close that we argue an iden., a phalanx of the most discordant ticof caese from observing an identity connexion between

cause

tion,

‘through premises.

mode of ar- ! we rise in the

We wish to know what air and he tells us, " it is music, or a is, gument be applicable, as of sound." We would be inscalcof composition from inditing common sense, to nonsense ? Shall the links of formed of the exact hour of the day, but of counting the seconds on his the great chain which binds an imitation he points to the sun, and e aculo the ) watch, be ?here rent asunder original, ETERNITY." Of, ,hall we nat conclude that the morbid of effect, shall not the

same

that

modification

instead

lates-"