large as a walnut attached to the upper part of the septum; and the tendency to this formation of tumors seemed to extend down the medulla spinalis. It has been remarked by Dr. BAILLIE, and other eminent pathologists, that the firmness with which the dura mater adheres to the inner table of the calvarium may be so much increased as to constitute disease. Dr. CRAIGIE, of Edinburgh, is inclined to think that this is not the case, but that, on the contrary, the effect of disease most frequently is to loosen the natural adhesions; a remarkable instance of which he details. A man, about thirty-five years of age, received a slight blow on the head; soon after which he began to complain of pain all over the forehead, and in the course of a few months was affected with amaurosis of both eyes. He next became epileptic, and, after lingering for six months, fell into a comatose state, and died a few days after. The body was examined by Dr. Duncan, jun. and Dr. Craigie. On opening the head, it was found that the scull-cap did not adhere with the usual firmness," but instantly dropt off, as soon as it was divided all round by the saw." It was unusually thin, and this attenuation was produced by the absorption of part of the structure of the internal table. In some few points, however, the bone preserved its natural thickness, "so as to form the spicule of which pathographical writers have spoken, in describing the appearances of the epileptic cranium." These spiculæ, it is to be observed, must have been produced in this case, not by the fresh deposition of osseous matter, but by its irregular absorption from the parts contiguous. The usual arterial connexiont between the dura mater and internal surface of the skull were necessarily absent, and no drops of blood appeared on either. The lateral and inferior parts preseeted the same appearance; and the membrane adhered very loosely to those portions of the basis of the cranium where it is in general attached with great firmness. Various examples of rupture of either ventricle of the heart are to be found scattered through periodical Journals, or mentioned in pathological essays, almost all of which have occurred in persons advanced in life; and, so far as we can judge, from the cases published by M. ROSTAN, it would appear to happen most frequently in females. It is also worthy of remark, that the left ventricle appears to give way in the majority of instances, and, in five cases related by the author just mentioned, this took place at the anterior part near the apex. One of the most remarkable cases of laceration of the heart hitherto recorded is to be found in the Number of this Journal for last month. It is detailed by Dr. ASHBURNER, and we must refer our readers to his account for the particulars: at present, we can only mention that both ventricles were ruptured, and in the left several apertures were found. This case, although very uncommon, is not, as its ingenious detailer supposes, without precedent: indeed, one very analogous has been lately published by Dr. BLAUD. This patient was only fifty-eight years of age, * Edinburgh Med. and Surg. Journal, October 1822. t Nouveau Journal de Médecine, Avril 1820. + Bibliothèque Medicale, Juin 1820. No. 287. с and had enjoyed good health until a week before death, when he became affected with pain about the heart, accompanied with a sense of constriction and anxiety. On examination after death, the right ventricle was found ruptured at the anterior surface to the extent of an inch; a similar rupture was discovered in the left ventricle. Besides this, there were three lacerations which did not penetrate the parietes of the heart; two on the surface of the left, and one on that of the right ventricle. In such cases, the structure of the heart seems to undergo a considerable degeneration, becoming thin, particularly at the apex, according to M. Rostan; and so soft and flaccid as to be easily torn. In Dr. Ashburner's case, it is described as resembling wetted brown paper. The observations of Messrs. Blaud and Rostan were published prior to the period embraced in this essay, but we have referred to them in illustration of the interesting case contained in our last Number. We have nothing to lay before our readers with regard to the lungs, except a well-marked case of melanosis affecting these organs; for which we refer to our Report of prevailing Diseases, contained in the Number of this Journal for December. Not long ago, a case occurred to a practitioner at Walworth, in which a child was born without an œsophagus. The parts were preserved, and are now in the possession of Sir ASTLEY COOPER. Au instance, in all respects analogous, took place in Germany in 1820. The child was born at the full time, appeared healthy, and took the breast as usual; but each time it attempted to swallow, the milk was returned through the mouth and nostrils, in such a manner as to threaten suffocation. It survived, however, for a week, during which time alvine and urinary evacuations took place, although not in the natural quantities. On examination after death, the stomach was found to have no cardiac orifice, but was united to the diaphragm by intervening cellular tissue; the gullet terminated abruptly in a cul de sac, and the esophagus was entirely wanting. "These cases are interesting chiefly on account of the regular appearance of alvine evacuations which occurred in them both. This circumstance furnishes a very conclusive proof that, at least, the chief part of the intestinal excretions consists of secretions from the mucous surface of the digestive tube, especially from the follicular apparatus, and of the excrementitious parts of the hepatic and pancreatic secretions."* Many cases are on record in which the stomach has attained dimensions so much above its natural size, as to be mistaken for dropsy of the abdomen; in such instances, the dilatation has, for the most part, originated in obstruction to the exit of the food by the pylorus. But, it is shown by the observations of M. ANDRAL, fils, that it is capable of becoming dilated to an extent almost incredible, independent of this cause. He states that a woman, aged sixty-five, was admitted last March into La Charité, much emaciated, and evidently labouring under organic disease of the stomach; the abdominal parietes had become so much attenuated as to enable M. Andral to trace its dimen * London Medical Repository, August. ↑ Journal de Physiologie, Août 1822. sions without difficulty. She suffered the usual symptoms of indigestion, and vomited, during nearly forty-eight hours, a large quantity of brownish fluid, which was rejected apparently without effort, and by a process resembling simple regurgitation. The tongue was natural, and the evacuations by stool unfrequent; the pulse very weak, and the skin. cold and dry. At the end of about a fortnight she sunk from debility, and the body was examined twenty-two hours after death. The stomach occupied almost the whole of the abdomen: it first descended vertically from the epigastrium, very nearly to the left iliac fossa; then stretched obliquely from left to right, the great curvature being behind the pubis, and resting on the uterus; from the right iliac fossa it ascended to the hypochondrium of the same side, terminating in the duodenum, which, as well as the rest of the alimentary canal, was healthy and undilated. The stomach contained an enormous quantity of brownish fluid; and, for the space of four fingers' breadth uext the pylorus, the mucous membrane was wanting, and an ulcerated surface formed; the parts being four or five times their natural thickness, and exhibiting a dense white structure when cut with the knife. The opening at the pylorus was large enough to admit easily the point of the fore-finger.A similar case is related by the same writer, in which the stomach had attained dimensions nearly as great; and a third is given by M. MAJENDIE, which occurred to him ten years ago, in the person of a relation of the celebrated Talma. This person was seventy-two years old, and, during twelve or fifteen days, received into the stomach a large quantity of liquids, and even aliments, by which the belly became so much distended as to resemble an enormous dropsy. He was then seized with vomiting, by which he evacuated, in a few minutes, as much as filled two large pails. After being thus emptied, he began to fill himself again. In a case of this kind related by BONNET, the disease was mistaken for ascites, and the patient tapped, by which means the contents of the stomach were evacuated, and the patient died. Here also the pyloric opening was free. An example of the extent to which the bowels may become distended, is to be found in the third volume of the Dublin Hospital Reports, in Dr. CHEYNE's interesting paper on Dysentery.* The size of the belly gave the patient the appearance of being in an advanced stage of pregnancy. On dissection, the small intestines were found to be seven, and the large intestines nine, inches in circumference. Two instances of great distention of the kidney have been placed on record: one, in the Edinburgh Medical and Surgical Journal for October, and the other in the Medico-Chirurgical Review for December; the latter being reprinted from the Number of the same Journal for July 1816. In the former, the cortical and medullary parts of the kidney had almost wholly disappeared, leaving nothing but a sac, which consisted of the proper external membrane of the kidney, and the internal men.brane much thickened. "It was divided into three large irregular cells, freely communicating with the dilated pelvis, into the apex of which the ureter, of its natural size, opened." About three Dublin Hospital Reports, vol. iii. and London Medical and Physical Journal, November 1822. pints of fluid escaped, which had the appearance of pus diluted with serum,-not having the smell, taste, or other properties of urine. A calculus was found, exactly corresponding in size to the calibre of the ureter. The tumor was about a foot long, and nine inches wide; it lay behind the peritoneum, filling the whole of the lumbar and part of the iliac region.-In Dr. JOHNSON's case, the patient was seen by various practitioners," and the general opinion prevailed that the disease was ovarian dropsy." The cyst is calculated to have held five or six quarts of fluid. In both these cases, the inner membrane was highly vascular, and probably secreted the contents of the bag. "It appears, in fact," says Dr. Johnson, "that, from some cause or other, the pelvis of the kidney had become distended to the size of the inner surface of the cyst, while the glandular substance had either become entirely absorbed, or was expanded between the pelvis and capsular tissues, forming, probably, the capillary bodies above described, and still retaining the secretory function."* Dr. HAVILAND, Regius Professor of Physic at Cambridge, has related a case of what he considers to have been solution of the stomach by the gastric juice after death. A young man, who had previously been in good health, was attacked with fever, and died. The stomach was removed from the body twelve hours after death: there were two holes in it, the larger situated on the posterior surface, near the cardiac extremity of the small curvature; it was about half an inch in breadth, and exceeded an inch in length: the smaller was near the other, and about the size of a sixpence. The edges of these perforations were smooth, and well defined. The mucous membrane was more vascular than natural throughout its whole extent, and there were small spots of what appeared to be extravasated blood lying beneath its surface in various places; in others, the coats of the stomach appeared very thin; and in one spot nothing was left but the peritoneum, the other tunics being destroyed. There was likewise a perforation through the muscular part of the diaphragm, large enough to admit the point of the finger: there was no appearance of ulceration, and Dr. H. attributes this likewise to the solvent power of the gastric fluid. M. NACQUART has placed on record an instance in which the gallbladder was wanting, having been removed by the progress of disease. A gentleman had an abscess of the liver, which burst externally, and discharged a great number of biliary calculi: after which he suffered, for many years, from hepatic complaints; and, at length, he died, at the age of sixty-eight, apparently of disease of the lungs,-or, at least, his death was much hastened by this occurrence. The liver was reduced to one-half of its ordinary dimensions, but is said to have been in other respects healthy. No gall-bladder was to be found, but the hollow marking its place was filled with a white fibrous substance, bearing some resemblance to cartilage. The cystic duct terminated at the middle of this depression. * Medico-Chirurgical Review, December 1822. + Cambridge Philosophical Society Transactions, vol. i. part ii. M. VALENTIN states, in his Medical Travels in Italy,* that he saw at Naples a gall-bladder, which had two ducts besides the cystic, both separately entering the duodenum. An instructive case of alvine concretions is to be found in the volume of the Transactions of the Royal Society lately published. A lad, named Chambers, was in the habit, during the summer of 1814, of eating large quantities of unripe plums, generally swallowing the stones. He pursued his usual occupations till the February following, when he became affected with diarrhoea, and he gradually sunk till the 6th of May, when he died. A tumor (supposed to be an alvine concretion,) had been distinctly felt before death, and, upon opening the body, three concretions were found compacted together in the arch of the colon at the left side, and one lower down near the rectum. This last was cut through, and contained a plum-stone in the centre. Another case is likewise mentioned, in which eight concretions were extracted from the rectum of a boy near Blackburn, two of them about the size of a hen's egg: they are of a light-brown colour, the external coat smooth, consisting chiefly of phosphate of lime and the ammoniacomagnesian phosphate. Vegetable fibres exist in these concretions, which are supposed to have derived their origin from the oatmeal which formed a large portion of the diet in the case first related. PHYSIOLOGY. Our readers are aware that MAJENDIE has been led to the belief that absorption is not a vital action, but effected by capillary attraction; and that the coats of all blood-vessels, as weli arterial as venous, possess a physical property by which we may explain all the phenomena of absorption. These conclusions were deduced, among other premises, from the result of certain experiments, which consisted chiefly in carefully detaching portions of great vessels,-separating them from the surrounding parts by the introduction of a card,—and applying poison (generally the nux vomica,) to the coat of the vessel. Under these circumstances effects were produced, varying in duration and intensity, according to the thickness of the vein or artery. Similar experiments have been performed by Dr. HUBBARD, of Philadelphia, but with results entirely different in the third of these only did the poison appear to affect the animal, and then the effect is attributed, with apparent probability, to its absorption by other textures. "Here we might have been led into a gross mistake, by attributing to its being absorbed through the veins effects which were undoubtedly owing to the operation of the poison in contact with other parts. But, upon examining the card, which was very thin, and, together with the vein, was kept constantly moistened, we found its under surface tasted strongly of the poison, the card being saturated with it. To this circumstance, undoubtedly, are attributable the slight effects produced." After this occurrence, a piece of sheet-lead was substituted for the card, and no * Voyage Medicale en Italie. Par le Docteur LOUIS VALENTIN. Philadelphia Journal, August 1822. |