Spirit of the British and American Periodicals, &c. DELIRIUM CONNECTED WITH CERTAIN STATES OF THE HEART IN FEVER. By Dr. HUDSON, of Navan. DR. HUDSON, the author of a valuable dissertation on fever in this Journal, has lately published some observations in our Dublin contemporary on the subject at the head of this paper. In 1840 a putrid or spotted fever prevailed in Navan and neighbourhood, and was very fatal. Generally the symptoms of debility were so prominent that wine and opium were necessary; but in several instances the low muttering delirium changed into that of a furious character, and ultimately into coma, on the exhibition of a small dose of opium. This led our author to make some inquiries into the conditions under which these phenomena occurred. An observation of Dr. Stokes led the way in this inquiry. "In the diminished impulse, and in the feebleness or extinction of the first sound, we have a new, direct, and important indication for the use of wine in typhus fever." Dr. H. says that every day's experience increases his confidence in the value of this mode of diagnosis-and he thinks that wine should never be given in the absence of the above symptom. But the rule for the exhibition of opium has not been laid down so accurately by authors. "Numerous observations have led me to conclude that opium agrees with that state of the cerebral circulation with which wine agrees, and vice versa, and that the indications derived from the signs of the heart are the same, and of equal value with reference to both. I have already stated that in several instances bad effects seemed to follow the exhibition of opium and tartar-emetic. A little observation showed that the same conditions were present which caused wine to disagree, and conversely, that those in which opium produced the best effects were precisely the same as those in which wine, freely administered, did good. In one of these cases the patient took, before sleep could be procured, a drachm and a half of the acetum opii, with six grains of tartar-emetic, in divided doses, and with the best effect, while in another, a single dose of six drops of the same preparation, combined, also, with the antimony, was followed by loss of speech and power of deglutition, tetanic rigidity of the muscles, coma, and death in rapid succession. Here were two opposite conditions of the system in the same disease. The states of the cerebral circulation, in particular, must have been different; but by what external character were these to be recognized? Those which appeared upon the external examination of the patients, in the several instances of each class, were-in the first, signs of a feeble heart, viz. the loss of impulse and diminution or absence of its first sound; in the second, strong impulse, and distinct and loud sounds. A corresponding difference of the appearances on dissection was found. In those who during life had manifested the signs of a feeble heart, this organ was softened, and the morbid appearances of the brain were those of venous congestion; in the others, the heart was firm and contracted, and the arteries of the brain were injected. A little consideration will show that the conclusion to which these observations would lead as to the connexion between the opposite state of the heart and corresponding states of the cerebral circulation, is consistent with the pathology of the latter affections, and might, to a certain extent, be anticipated by reasoning; for, admitting the truth of the proposition that 'the pathology of the brain is, in many instances, intimately connected with and dependent upon the pathology of the heart,'* we would (reasoning a priori) infer that cerebral excitement, attended with increased strength and activity of the central organ of the circulation, should be found to depend upon a sthenic or arterial congestion, while a feeble state of the propelling power would lead to more or less stagnation in the venous current, and congestion in those vessels with, what always co-exists with such congestions, a diminished supply of arterial blood-this last condition being, in all probability, the true cause of the physi ological effects of venous congestion of the brain. We would thus suppose the existence of two opposite pathological states of the brain, requiring opposite treatment, and yet possessing external characters and symptoms having so close a resemblance as to require frequently more than ordinary powers of discrimination to distinguish between them. Such a supposition is consistent with the analogy of other affections, especially of delirium tremens.' Of this disease every practitioner recognizes at least two varieties, one of which is controlled by opium, with the precision and certainty of a specific; while another case, differing so little in its external characters as to be frequently confounded with it, is exasperated and rendered fatal by this medicine. One requires stimulants, the other bleeding and purging. Dissection reveals passive venous congestion in one case, and determination of blood to the brain or membranes in the other." Dr. Hudson adduces several cases in illustration, to which we must refer our readers. The stethoscopic indications abovementioned are deserving of especial attention by the practitioner. MEMOIR OF A GENTLEMAN BORN BLIND AND SUCCESSFULLY OPERATED ON IN THE 18TH YEAR OF HIS AGE. By Dr. FRANZ. At the birth of this young gentleman (the son of a physician) the eyes were found to present a two-fold defect of organization. Both eyes were turned inwards to a great extent-and cataract existed in both. Towards the end of the second year, keratonyxis was performed on the right eye, which was followed by iritis, and wasting of the eye-ball. Within the next four years, two similar operations were performed on the left eye, without any success, but with no destruction of the eye. The colour of the opacity, at length, became of a clearer white, and some faint perception of a strong light was experienced by the boy. Into the long and minute description of the state of this gentleman's eyes in his 18th year, (1840) we cannot go. It appeared that the right eye was completely amaurotic, and the left, which had become atrophied, was the only one considered fit for an operation. The following were the steps taken: "On the 10th of July, 1840, in the presence of Dr. Swaine, and with the kind assistance of Messrs. F. Fowke and F. Steinhäuser, I made an incision in the cornea upwards, and introducing a pair of fine curved forceps, armed with teeth, into the posterior chamber, I seized the anterior wall of the capsule, by passing one of the blades of the forceps into its small aperture, and attempted by pulling it slowly to separate it from its adhesion with the uvea and its peripheral connexion, in which I succeeded without producing a prolapsus of the vitreous body, or tearing the capsule, which I now removed. After this proceeding, a large piece of the lens of an opaque colour, probably the nucleus, presented itself in the pupil, which was easily removed from the eye by means of Daviel's spoon; the pupillary aperture then appeared perfectly clear and black. The * Dr. Law on Disease of the Brain dependent on Disease of the Heart, Dublin Medical Journal, No. 50. patient was now turned with his back to the light, for the purpose of trying a few experiments as to his sight, but from these I was obliged to desist on account of the pain which the light produced in the organ. Both eyes were then closed with narrow strips of court-plaster, and the patient carried to bed. Venesection, local bleeding, fomentations with iced water, continued without intermission for about forty-eight hours, together with the scrupulous observance of the most severe regimen, barely succeeded in keeping down the inflammation, the effects of which in this case, where but one eye offered hope, were much to be dreaded, if it should surpass that degree which was necessary for the healing of the wound in the cornea. This process went on and terminated so favourably, that the cicatrix, situated close to the sclerotica, is now scarcely visible. The patient suffered from muscæ volitantes and from a considerable intolerance of light, pain being produced by even a mild degree of light falling on the closed lids. The muscæ volitantes were greatly mitigated, and the intolerance of light ceased, after the lapse of a few weeks, by the use of proper pharmaceutical remedies, by local bleeding, change of air, &c., and the employment of the ophthalmic fountain of Professor Jungken, which I have fully described in the Medical Gazette, vol. xxvii. p. 444. To promote the development of the power of vision, the use of the fountain was continued twice daily, with Pyrmont-water and latterly with simple spring-water, for the space of three months, when it was discontinued, as it began to irritate the eye." On opening the eye on the third day, he perceived a blaze of light, and all objects confused and in motion. He could not distinguish any object. The pain forced him quickly to close the eye. Gradual exposure of the eye to light habituated the organ to its stimulus; and when vision became tolerably distinct, all objects appeared so near to him that he was afraid of coming in contact with them, so that he was constantly correcting the sense of sight by that of touch. On the 21st September, 1840, Dr. F. operated on both eyes for the congenital strabismus. This operation was so successful, that the gentleman's personal appearance was much improved. In November he was able to read the names over the shop-windows, and to tell the time, to a minute, by St. Paul's clock. The tide of human existence, however, in the streets, so confused and confounded him, that at last he could see nothing. By the Spring of 1841, the sight was much improved-and improving. The case, altogether, is very creditable to Dr. Franz, as well as interesting to the profession and the public. The paper is published in the Philosophical Transactions for 1841, Part I. A NEW PROCESS FOR PURIFYING THE WATERS SUPPLIED TO THE METROPOLIS, &c. This is a patent process, the secret of which " will be set forth in the specification." So was the secret of Dr. James, but nobody could ever make the fever powder by that specification. We learn, however, that the Thames water is to be purified by means of quick lime. The state of purity to be attained by the new process, is that which would be effected by "heating the water till it boiled, and kept at the boiling point for two hours." Thus then the muddy and turbid infusion of dead dogs, cats, rats, garbage of hospitals and shambles, washings of water-closets, drainings from common-sewers, and all utterable and unutterable abominations, is to be brought to the state of a homogeneous decoction, by two hours' boiling, and this hell-broth is to be offered to the inhabitants of the metropolis as a PURIFIED WATER!! The great object and anxiety of the patentee seem to be the precipitation of the chalk from the Thames and River water. Thus, an experiment is stated, in which it is reckoned that two pounds of chalk are partly dissolved and partly suspended in 540 gallons of metropolitan water, and that when the patent process is applied, "both pounds of chalk will be found at the bottom after subsidence. The 540 gallons of water will remain above, clear and colourless, without holding in solution any sensible quantity either of caustic lime or bicarbonate of lime." So, then, we are to swill and swallow contentedly the essences of every kind and species of filth that the most fertile imagination can conceive, in gratitude for having got rid of a few grains, daily, of chalk!!! We shall here take leave of our ingenious patentee, by making him a proposal, which, we sincerely hope, he will accept. Let him leave us the CHALK in the Thames water, and take all the other ingredients-FILTH, SOIL, and SORDES, to himself as remuneration for the trouble of his chemical purification. PHYSIOLOGY OF THE VOICE. "Exceptio probat regulam." Mons. Reynard has published a case in the Gazette Medicale, where a galleyslave attempted suicide by cutting his throat by transfixing the larynx, from side to side. There was considerable hæmorrhage. The esophagus was wounded, but not severed. Sustenance was conveyed into the stomach by means of a tube. The subsequent inflammation closed up the air passage above the wound. He breathed entirely by the laryngeal opening, when a tube was established. M. Reynard made experiments to ascertain whether any air could be expelled or inhaled through the glottis, and concluded that the natural passage was completely closed. Yet speech remained tolerably distinct. We doubt the fact, and suspect a fallacy. Mr. Price, a jeweller at Portsmouth, was operated on by the late Dr. Denmark, and Dr. Johnson, in a case of laryn gitis, when the patient was in articulo-mortis. The trachea was opened, and Mr. Price breathed through the tube from that day to this (for we believe he is still alive) some 25 or 26 years. Now here, although the passage was not entirely closed, for a very small stream of air could be forced through the glottis, yet the power of articulation was lost. With this fact before our eyes, we cannot assent to the correctness of M. Reynard's statement. Were we to believe that a man could speak without the organ of voice, or hear without the organ of audition, we ought, in common justice, to believe that Miss Okey saw through her navel, and that the doctor's "bottle-imp" could foretell the issue of a malady, without seeing the patient, or having the slightest acquaintance with the anatomy, physiology, or pathology of diseases! PARTIAL HYPERTROPHY OF THE HEART. By Dr. JOHNSON. By the term which I have used, I mean a diminished size of the heart, as a whole, while certain portions of it are in a state of hypertrophy. It corresponds with the concentric hypertrophy of authors. The Hon. Mr. R, about 40 years of age, came under my observation some five or six weeks before his death. He was greatly emaciated-sallow in his complexion-and with extremely feeble circulation. The pulse was like a thread, at the wrist, and the action of the heart was scarcely audible. The appetite was nearly wanting, and as food produced distressing feelings, he had long adopted a very rigid and abstemious diet, which probably tended to increase the emaciation. I examined him with the greatest care from head to foot, without being able to detect any lesion that could account for the progressive waste of flesh. The patient (if he could be called such) went direct to Leamington, and never took anything which I prescribed. He placed himself under Dr. Jephson, who gave favourable hopes to his family of ultimate recovery. A month's treatment, however, produced no amendment, and Mr. R. returned, with great difficulty, and in the most exhausted state to London, when he came again under my care. The emaciation was now at its utmost extreme, and as he could take very little nourishment by the mouth, he was supported by strong beef-tea thrown up into the colon every eight hours. The pulse was now scarcely perceptible at the wrist, and the action of the heart inaudible in any part of the chest. He had no cough-clean tongue-intellects unclouded—and, after lingering about a week, he ceased to exist-pale and pulseless, like a person expiring of cholera. On dissection (by my son) 24 hours after death, all the organs and structures in the body, with one exception, were sound. On opening the chest, the lungs, on both sides, completely collapsed, leaving in view a heart of the most extraordinarily small dimensions. The pericardium was intimately glued to the heart, so as to be incapable of separation, so ancient and complete had been the adhesion. The heart itself was not more than half its natural size; yet its parietes (ventricular) were full an inch in thickness. This dimunition of general size, with hypertrophy of the walls, had so encroached upon the cavities, that the left chamber could not contain more than three tea-spoonfuls of blood! The consequence was, that at each ventricular contraction about one-fourth of the normal or natural quantity of blood was discharged from the heart into both aortic and pulmonary system. The general emaciation of the whole body_thus so very imperfectly supplied with the vital fluid, is readily accounted for. In respect to diagnosis during life, I conceive that in a case of this kind, and to this extent, it would require more diagnostic means than we yet possess to detect the true nature of the organic lesion. CARLISLE. PERIODICAL versus PERMANENT DUTY IN THE MEDICAL CHARITIES OF CARLISLE. A sharp discussion and correspondence have lately taken place between the medical gentlemen of Carlisle and the Governors of the Dispensary and of the Fever Hospital of that place. The great majority of the medical practitioners of that city proffered their gratuitous services to the above institutions, coupled with the proposal that all the said practitioners, who volunteered their services, should have periods of duty, in rotation, assigned them, instead of that duty being permanently allotted to certain individuals elected for that purpose. To this proposal the GOVERNORS demurred: but, whatever reasons or arguments they may have employed among themselves, there is nothing like either reason or argument broached in the official correspondence. The principle of rotation might not, indeed, prove applicable to, or practicable in, the metropolis, or in very large provincial cities, where the number of medical practitioners happen to be out of all proportion to the number or extent of the charitable institutions: but in such a place as Carlisle, containing, perhaps, not more than 20,000 inhabitants, the plan is perfectly feasible, and would, we conceive, prove eminently beneficial to the sick, to the public, and to the profession. There could not be the slightest reason to apprehend that unqualified individuals would volunteer their services in a public institution, where exposure would as certainly follow error or ignorance, as the shadow follows the substance. By this plan, knowledge would be more equally diffused among the medical No. 87. 24 |