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have no name in this country, in which which appear to be the true seats of their those diseases are scarcely known. Also to poisonous action. that decay of vegetable matter to which, to a These poisons produce death either by greater or less extent, we attribute several of asphyxia or syncope, or by sudden and irrethe severest scourges of humanity-plague, mediable, yet generally to the anatomist, ague, dysentery, and several other formidable indiscernible organic lesion, probably of the diseases; amongst the rest, and though last, brain; to speak more fully, they destroy life not least, the redoubted cholera.

in some one of the three following waysMineral substances are no doubt also more either by a suspension of the function of the or less liable to changes that might be called phrenic nerve, owing to cerebral torpefaction, degenerations, from the action of external whence asphyxia, arising from suspended influences ; but in the history of practical action of the diaphragm; or by violent irritatoxicology, I do not at this moment recollect tion of the motor nerves of the spine, whence a striking instance of a mineral body having, asphyxia ; again, owing to tonic spasm of the by spontaneous change of composition, been pectoral muscles, fixation of the ribs, and converted not merely from esculent or nutri- immobility of the chest ; or, secondly, they tious, but even from innocent to poisonous. prove fatal by sudden arrest of the circulation,

In a physiological point of view, also, owing to a paralysis of the heart, produced vegetable are distinguishable from mineral through the cardiac nerves, or still more cirpoisons. Poisons in general are divisible cuitously through the brain, and eighth pair, into two great classes; the one, immediate or par vagum, that is, by syncope ; or else, and local in their action ; the other, mediate thirdly, they cause instantaneous death, i. e. and remote-the one proves noxious by ex- destroy life by an instantaneous overwhelmciting in the part to which they are applied a ing shock to the whole nervous machinery, morbid action, which, if fatal, proves so gene

or to some of its principal portions, or, as rally, ulteriorly, and indirectly ; the other

Gall would have it, to some principal organs class proves fatal, if not altogether, yet prin- within the cranium, whence a sudden cessacipally by a remote agency, a morbific influence tion of sense, thought, voluntary power, being transmitted from the part to which innervation, respiration, and circulation, tothey are applied through the circulation, or gether with complete insusceptibility of realong the nerves to the brain and lungs, or to excitation, by any known means. This form the heart, or to all three together. In the of death, I may remark, though overlooked case of the former, or local poisons, death is by Bichat, and most, if not all, subsequent the result of morbid actions in the parts first physiologists, is, notwithstanding, of frequent exposed to the noxious substance; and such occurrence. It has in practice been seen in morbid states have no specific peculiarity, greatest perfection in the operation of gaseous but resemble the ordinary effects of the most poisons, such as sulphuretted hydrogen, or frequent and familiar morbific causes ; such the miasm of plague, or variola, when freely as cold, mechanical injury, &c. Exam- inspired ; but has also been observed to folples of this class of poisons are corrosive low the application of some vegetable poiand acrid substances, such as the mineral sons, particularly the prussic acid, adminisacids, the pure alkalies, mercurial, cupreous,

tered in large doses, or under very favourable and other acrid substances, mineral, vegetable,

circumstances. A drop, for example, of that or animal ; they destroy life sometimes, but acid, introduced into a vein, has been obonly when given in very large doses, by sus- served, by Magendie, to strike the subject of pending at once the play of the brain or the experiment as instantaneously dead as heart, or of both, and of course of the lungs ; would a thunderbolt. on the same principle, probably, as a fright, a But to return from this digression: under blow, or other violent, physical, or moral im- the second head, or that of poisons of remote pulse has been often known to do. Under or sympathetic action, fall the principal vegeother and ordinary circumstances, the deadly table poisons. In this division we find effects of acrid poisons are attributable to the opium, prussic acid, woorara, ticunas, upas, local irritation or inflammation they produce, and other strychnine poisons, hemlock, henand are to be encountered as other gastritic, bane, thorn-apple, oxalic acid, in most cases, enteritic, or other local inflammatory affec- alcokol, monkshood, tobacco, &c. &c. ; in fact, tions. The latter class of poisons, which the leading poisons of vegetable origin, Now have been called in contra-distinction to the the former, or section of poisons of local local, general poisons, owe their power of morbific action, contains the great majority acting noxiously on remote parts to the ana- of the poisons of the mineral kingdom, ex. gr. tomical and physiological relations existing copper, silver, tin, mercury, and their combetween the brain and heart, and all other pounds, arsenic, in some measure, barytic organs. In the part to which they are and antimonial poisons, in part, the mineral applied, they produce often no striking dis- acids, and concentrated alkalies, altogether, turbance; but are, it would seem, potentially, range themselves amongst local poisons. by the vascular nerves, or in substance, by There is, unquestionably, a large class of the venous current, transported to the centres vegetable poisons whose action is likewise of sensation and motion, and of circulation, local : in numerical amount, indeed, by much

the largest portion of the botanico-toxicolo- ricarditis, carditis, and inflammation gical catalogue; but in point of individual

of the internal membrane, both of importance or general interest, this class of

the heart and arteries. We observe, vegetable noxious substances is of very minor consequence. Amongst other reasons we are with pleasure, that Dr. Hope has uniwarranted in neglecting them in this place, formly followed the French system, because their operation is direct, local, and of giving precedence to the morbid uncomplicated; because they are quite un

anatomy. This mode of arrangement, suitable for the purposes of the homicide, from being liable to effect their own expulsion

obviously imperative in those disby vomiting, and from being frequently cha- eases of cavities or organs which are racterised by strong sensible qualities, and mainly characterised by altered phyfrom being further inconveniently rapid and sical conditions, will, we are perstriking in their operation; and lastly,

suaded, be found most convenient because their treatment differs, after a very short interval from the ingestion, little, if at

and impressive in all records of disall, from that required by ordinary local irri- ease. In our preceding Number, we tation or inflammation.

had occasion to notice the fidelity With the preceding observations I shall

and truly pictorial vividness of Dr. conclude the present address. My reason for occupying the time of the society with a

Hope's anatomical descriptions. As discourse of a popular complexion, and having justifying of our praise, and, at the so little pretension to a scientific character, I same time, as a model for the imita. have already alluded to, namely, to leave quite tion of our young pathologists, we open for future adoption, any order or principle of proceeding the society may hereafter think

would willingly quote, if our limits fit to prescribe to its lecturers. I have had did not forbid us, the whole of his a further private object in this line of con- account of the anatomical characters duct, and have not unwillingly availed myself of pericarditis, which we esteem quite of an opportunity of laying before the society

a masterpiece in this order of writing. some matters which, though of a slight and

We feel scruples in violating the superficial description, if considered in their relations to toxicological science or practice, unity of this admirable picture by yet have seemed me not altogether desti- disconnected citations, and refer the tute of interest, or unworthy of the ear of the

reader to the work, especially to society. These may be considered as a fantasia prelude to the principal performance, and are submitted, not without diffidence, to

“ The anatomical characters of acute inthe judgment of my fellow members.

flammation of the pericardium are, 1. preter-
natural redness of the membrane ; 2. coagu-
lable lymph adhering to its surface ; and 3.
fluid effused within its cavity."

Again,
Review.

1. Preternatural redness of the pericardium. The redness very seldom pervades

the whole of the inflamed portion. It presents A Treatise on the Diseases of the

itself sometimes in numerous small scarlet Heart and Great Vessels, com

specks with a natural colour of the intervenprising a new view of the Physio- ing membrane, sometimes in spots of greater logy of the Heart's Action. By J. or less magnitude formed by the agglomeraHope, M.D. Senior Physician to

tion of the specks, and sometimes in patches the St. Mary-le-bone Infirmary have, almost without exception, a dotted or

of considerable extent. Even these, however, of London, formerly House Phy- mottled character. In a drawing before me, sician and House Surgeon to the which I made from a case of very acute and Royal Infirmary of Edinburgh, rapid pericarditis, nearly the whole of the &c. &c.

reflected membrane, underneath a layer of

soft primrose-coloured lymph, is of a vivid, (continued.)

mottled and dotted red." Part II. is dedicated to the inflam

“ 2. Coagulable lymph adhering to the .

surface of the pericardium.— The inflamed matory affections of the heart and

pericardium secretes serum and lymph congreat vessels, under the heads of pe- jointly, and in a, fluid state, from the same

page 84.

vessels. Soon after the secretion has taken stretching the left side, and especially by place, the lymph concretes, while the serum pressure between the præcordial ribs, and remains fluid. The former, when recent, is forcing the epigastrium upwards underneath of a pale straw-colour, and of a soft, tender the left hypochondrium. When the inflamconsistence, becoming firmer and more tena- mation is only subacute, the pain is more or cious as it grows older. Though occasionally less dull, and does not lancinate. The next deposited in detached lumps and spots, it symptoms are, inability of lying on the left generally forms continuous layers, sometimes side, and sometimes in any position but one, covering a portion only, but more commonly which is most commonly on the back; dry the whole, or nearly the whole, of the peri- cough; hurried respiration ; palpitation of cardium. The thickness of the deposition the heart, the impulse of which is sometimes may vary from a line to an inch; but, from violent, bounding, and regular, though its a line and a half to three lines is its ordinary beats may, at the same time, be unequal in mean. Its adherent surface is smooth; the strength ; at other times it is feeble, futteropposite is rough and singularly figured.” ing, and irregular ; pulse always freqüent, “ 3. Fluid effused within the cavity of the

and generally, at the onset, full, hard, jerkpericardium.-It has been stated that serum

ing, and often with a thrill. Sometimes it is effused conjointly with lymph, from the

maintains these characters throughout, but vessels of the inflamed pericardium. This

more commonly it becomes, after a few days, fluid is sometimes transparent, and either of

weaker than accords with the strength of the a faint yellow more or less tinged with green,

heart's action, and, in the worst cases, small, as that of the interior of a lemon, or of a

feeble, intermittent, irregular, and unequal. pale fawn colour; at other times it is less Occasionally it possesses the latter characters transparent, but very seldom milky or opake

from the commencement ; whenever they from containing particles, filaments, or flakes

exist, they are accompanied by dyspnea; a of imperfectly concrete albumen. Its quan

constrained position, deviation from which tity, though variable, is in general consider

induces a feeling of suffocation; extreme able at the commencement, that is, within anxiety ; a peculiar drawn or contracted the first two, three, or four days of the dis- appearance of the features, occasionally with not unfrequently amounting to more

the sardonic grin; faintness, constant jactitaease, than a pint."

tion, insupportable distress and alarm, cold

perspiration, and, finally, from obstruction of “ The muscular substance of the heart is,

the circulation, by intumescence and lividity in general, not affected by pericarditis ; but

of the face and extremities." sometimes it is rendered redder or paler, browner or yellower, harder, softer, or more

He afterwards describes the phylacerable, than natural. These changes result from inflammation propagated from the

sical signs, pp. 108 and 110. We pericardium to the muscular substance. must confess that these physical inThey will be more fully considered in the dications, common as they are to a article Carditis."

vast number, not only of the organic, We now come to the diagnosis of but of the functional derangements pericarditis, which has always been re- of the heart, appear to us almost garded as, and very often is, eminently valueless in the proofs of differential doubtful and difficult. Laennec has

diagnosis. Dr. Hope's plan of treatclassed it with polypi and aneurism ment we think most judicious and of the aorta, as diseases which he

efficient. Prompt and copious deplewas unable to recognize with cer- tion from the arm at first, and by tainty ; and he terms the diagnosis covering the region of the heart with of pericarditis a kind of divina- leeches, with the other antiphlogistic tion,” in which the most skilled ob

measures, constitute, of course, the server is as frequently in error as

leading features of his practice, and successful, (tom. II. p. 660.) Dr. need not be enlarged upon here. But Hope thus enumerates the most usual

he justly continues, " the antiphlosymptoms of the disease :

gistic treatment alone is not to be “ Acute inflammatory fever; a pungent,

relied on."-p. 120. “Antiphlogistic burning, lancinating pain in the region of measures can neither prevent the the heart, shooting to the left scapula, shoul- effusion of lymph, nor with any deder, and upper arm, but rarely descending below the elbow, or even quite to it. The

gree of certainty, cause its absorppain is increased by full inspiration, by

tion. Mercury can do this,

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" is not very

visibly displayed in iritis: mercury, walls of the heart, with or without therefore, is the sheet anchor of the modification of its cavities, evidently practitioner.”—p. 121.

originating in an acute or chronic His remarks on adhesion of the inflammation, either of the pericarpericardium are valuable, and in some dium, of the internal membrane of respects novel.-— Vide pp. 126 and the heart, or of the aorta. Carditis is a 127. We think his observation that, disease of extremely rare occurrence. " I have never examined a case of Indeed, muscular tissue in general, complete adhesion of the pericar- is singularly exempt from inflammadium, without finding enlargement tory action; its purulent infiltration of the heart-generally hypertrophy being most commonly, if not always, with dilatation,” deserving of much referrible to suppuration of the intesattention. He thus attempts to ex

tinal cellular structure. Dr. Hope plain the co-existence of these two quotes from Dr. Latham, one case of structural changes :

universal carditis, which seems to be

the only example on record. “ Par“ How adhesion occasions hypertrophy is tial carditis," says he, easily understood; for the organ must increase its contractile energy, in order to con

uncommon, &c.”—p. 134. tend against the obstacle which the adhesion, Chap. III. contains an admirable by shackling its movements, presents to the history of arteritis, and is especially due discharge of its function; and, as ex

valuable for its just discrimination of plained in the article on hypertrophy, increased action leads to increase of nutrition.

the post mortem appearances, which The cause of the co-existent dilatation is not

are really symbols of pre-existent less manifest. As the shackled organ trans- disease, from those which are merely mits its contents with difficulty, it is con- cadaveric. One of the most elabostantly in a state of greater congestion than

rate of the recent French works, the natural, and, as is more fully explained in the article on dilatation, permanent distention

Traite of Bertin, edited by Bouillaud, is the most effective cause of this affection. is disfigured by most total mis-appreWhen the muscular substance is softened, hensions of the nature of these apas frequently happens, dilatation takes place

pearances. Redness of the internal much more readily, in consequence of the

membrane is, by these writers, unideficient elasticity or tone of the heart's parietes."

formly ascribed to previous inflam

matory disease; and since a red tinge Now, without at all disputing the is far from uncommon in the lining justness of this reasoning, we think

membrane of the aorta and large that the inflammatory process itself, vessels, they have been compelled which gave birth to the pseudo-mem

into the gratuitous admission of a branous attachments, may in many disease without symptoms. Laennec cases be also the parent of the hyper- was the first to demonstrate by extrophic dilatation. Wherever,” periment, that the various shades of says Andral, (Clin. Med. t. III. scarlet, violet, and purple dye, are, p. 460), “ the muscles of organic in a large proportion of cases, prolife are in contact with an inflamed

duced by cadaveric imbibition of the membrane, whether mucous or serous, colouring matter of the blood. Our they have a remarkable tendency to author has described all these apbecome the seat of a more active

pearances and experiments with fidenutrition. This is especially mani- lity and precision, and has adopted fest in the muscular coat of the the views of Laennec. He then prostomach, intestines, and bladder, ceeds to a more decided order of apwhen their mucous investment is af

pearances, furnishing the evidence of fected with chronic inflammation."

inflammation. He appeals to many cases in which

“Whether redness be due to vascularity he has witnessed hypertrophy of the alone, or to this conjoined with imbibition,

its inflammatory nature is known by the pre- exhibited with advantage, by that sence of other anatomical characters of inflammatinn. These are thickening, swelling,

enlightened and sagacious physician, and puffiness of the inner membrane ; an

Professor Alison. effusion of lymph on either its free or adhe- Part III. being devoted to the orrent surface ; and a preternatural vascularity, ganic affections, is necessarily the with softening and thickening of the middle

most bulky and most important. The arterial coat. Each of the coats, also, may

first chapter treats of Hypertrophybe separated from the other with much greater facility than natural, by scraping

a disease which has only of late with the nail or scalpel. The internal and years been analysed with scientific middle coats, in short, present all the pheno- precision, and distinguished by a just mena of the adhesive inflammation as it displays itself in other membranes.”

nomenclature, from the alterations of

capacity of the cavities, with which We cannot withhold our praise it is often, but not necessarily, acfrom the account of the abrasions, or companied. Dr. Hope has, in p. 187, ulcers, as they have been less pro- very distinctly characterized the seperly termed, of the internal mem- veral varieties of hypertrophy, judibrane, in pp. 151, 152, 153. Dr. ciously discarding the terms active Hope proceeds to the morbid altera

and passive uneurism of Corvisart, tions in the coats of arteries, which which, as often inconsistent with the appear to be of chronic formation.- actual state of anatomical science, “ The most simple morbid alteration is, a

cannot be too soon consigned to obloss of elasticity, generally, accompanied with

livion. The exact description of hyincreased density and opacity, of the coats of pertrophy, in pp. 183, 184, is folthe artery. This state is sufficient of itself to lowed, pp. 187, 188, by an analysis give rise to dilatation, because (as will be

of the causes in which it has its more fully explained under the head of dilatation of the aorta) the elasticity and tone of origin. an artery are the powers by which it resists Section III. contains, compressed the distending force of the blood.

within a few pages, an admirable The next and the most common morbid

explanation of the order and mode appearance is that of small, opake, straw

in which the several compartments of coloured spots, immediately underneath the lining membrane, with slight inequality and

the heart undergo organic changes, corrugation of the membrane around them. from an obstacle before them in the At a more advanced period the depositions course of the circulation. We strongly form considerable, slightly elevated patches,

recommend this section to the atten. which becoming confluent, sometimes overspread the whole surface. Some of these

tive perusal of the reader, as it conpatches have much the appearance and con

stitutes by far the most simple, yet sistence of bee's-wax, or cheese, though in perfect key, to an extremely intricate general their cohesion and flexibility are

and perplexing subject, which has yet greater. These are usually denominated

been given. steatomatous. Others, presenting nearly the same colour, have a fibrous or ligamentous appearance ; while others, again, are more translucent, white, and elastic, like cartilage, or fibro-cartilage."

A Critical and Experimental Essay His description of the symptoms on the Circulation of the Blood; of arteritis is, from the nature of the

especially observed in the Minute and subject, necessarily imperfect. The

Capillary Vessels of the Batrachia, disease is, indeed, eminently obscure,

and of Fishes. By MARSHALL and will, we fancy, rarely be recog- Hall, M.D. F.R.S. E.M.R.I. nized, except in the anatomical

M.L.S. &c. 8vo. pp. 187, Ten theatre. In the treatment, p. 175,

Plates. London, 1831; R. B. Dr. Hope recommends mercury, un- Seely. der certain limitations.

In a suspected case, in the clinical wards of This work is a critical and experi. Edinburgh, we have seen mercury mental examination of the received

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