« ForrigeFortsæt »
tulate the author on the complete said to be caused by dyspepsia; "good success with which he has so ably air and plenty of exercise are remeexecuted his difficult undertaking dies;” and apoplexy the consequence. He has produced a work of reference As the incipient disease of the heart and authority which must have a might be removed, the recovery was place in every medical library. After regarded, by those who assumed this having fairly acknowledged the re- class of diseases to be incurable, as a spective claims of Corvisart, Kreysig, proof that the malady was merely Burns, Laennec, and Bertin, he clearly dyspeptic. Hence dyspepsia was said proves, that much more evidence is to cause disease in the head, which wanted to elucidate the nature and was really caused by disease in the proper treatment of the diseases un- heart. The converse of this error is, der notice. To supply a part of this in mistaking nervous or dyspeptic evidence, he performed a series of ex- palpitation for disease of the heart. periments before a number of the The frequency of cases of this kind," distinguished physiologists and pa- says Dr. Hope, "especially amonget thologists of this metropolis, which men of studious habits (and more parenabled him to explain the physical ticularly, I have noticed among those signs of diseases of the heart. He of my own profession), is truly surdisproves some of the opinions of the prising; and, as it has always been illustrious Laennec, to whom he justly considered difficult, and by many imoffers the high eulogy to which that possible, to distinguish the two affecgreat physician is so eminently enti- tions, the alarm created is sometimes tled. He communicates the long- distressing." The author assures us wished-for information, the correct that the discrimination may be made diagnosis, and the effectual treatment with ease and certainty, and has given of cardiac diseases. He affords abund- a separate article on the subject. ant evidence of the curability of these He next observes, that an immense maladies, when recognisable, as they number of asthmas and of universal now are, in their incipient stages. dropsies result from disease of the He states, on the grounds of incon- heart. If the cause be overlooked, testable experience, that in their early the asthmatic is harrassed with a farstages, they are, in a large proportion rago of inappropriate and unavailing, of instances, susceptible of a perfect not to say pernicious remedies; and cure; and in general may be so far the hydropic is treated with dangerous counteracted as not materially, and activity for imaginary affections of the sometimes na“; at all, to curtail the liver, the lungs, or the kidneys." On existence of the patient. Such are the other hand, if the cause be dethe direct practical improvements to tected in the incipient stage by prebe expected from a better knowledge cautionary measures, both the one of diseases of the heart. These are effect and the other may in general vast improvements indeed; but there be prevented. The judicious and taare collateral ones of no less magni- lented author next adverts to carditis tude. These are exemplified by the and peri-carditis, induced by metasfrequency of apoplexy and palsy, in tasis of rheumatism ; and informs us alliance with hypertrophy of the heart; also, that disease of the heart, accom. which, if overlooked, may lead to panied with obstruction of the circufatal results. An inattentive or in- Iation for any considerable period, projudicious observer may suppose that duces enlarged liver, and its ordinary in all cases an apoplectic tendency consequence, abdominal dropsy. Yet is to be removed by active exercise, the treatment is solely directed to the which will suddenly produce the dis- liver, and not to the heart. Persons ease which it was intended to remove. affected with cardiac disease, are exAgain, organic disease of the heart is tremely liable to rapid and destructive
INFLUENCE OF THE NERVES
inflammation of the lungs. If copious body in the state of collapse in cho. and repeated venesection is employed lera, typhus, scarlatina, and numerous the patient sinks suddenly. The other diseases in which the vital characters of the pulse may be de- powers are greatly depressed. We ceptive, and fevers or inflammation have examined Mr. Le Beaume's apfrom diseases of the heart, and blood- paratus, which is applicable to the letting may be carried too far, or not whole or any part of the body. In far enough. In fine, there is scarcely cases of rheumatism or paralysis of an affection with which diseases of particular parts, it can be applied with the heart may not be interwoven. facility. We strongly recommend this Such then are the vacuities left by cheap and really useful production to preceding writers; and such the ad- our readers. vantages to be anticipated from their being supplied. The author describes the arrangement which he adopts, which is extremely correct and ac- OVER MUSCULAR CONTRACTILITY. curate. He selected his cases from the Hospitals; and he invariably re
- olen corded his opinions and diagnoses To the Editors of the Medical and before the death of the patients,
Surgical Journal. which were astonishingly correct.
GENTLEMEN, These are attested in some cases by the signatures of the medical officers I shall feel much obliged by the inserof various Hospitals in London, tion in your valuable Journal of the Edinburgh, Paris, and Rome. The following observations, if you should accuracy of Dr. Hope's opinions on
consider them worthy : the nature of the most opposite dis
Physiologists, I believe, consider the eases of the heart were invariably contractility possessed by muscular attested by dissection.
He is un
fibre to be an inherent property ; they commonly well versed in the diag- suppose likewise this property to be noses and treatment of diseases of under the regulation of the nerves, this organ; and will be consulted in
and that their influence disposes to such cases with the greatest advan- contraction.
Dr. Mason Good says, tage, both by the profession and the the nervous influence is continually public.
being communicated in jets. There are several objections which may be
urged against this view of the influOn the Portable Sudutory or Hot Air
ence of the nerves. Bath, with Cases illustrative of its
If nervous influence is continually Medical Powers in various Diseases, being sent into a muscle, it must either and its utility in Cholera ; with Di- give rise to constant contraction, or it rections for its administration ; to
must accumulate there. gether with Remarks on the appli
It seems strange, that an additional cability of Galvanism in the first quantity of the self-same influence stage of that Malady.---By M. LE that predisposes to contraction should BEAUME, Medical Galvanist and be required in order to produce actual Electrician in Ordinary to the King.
contraction. The theory, in fact, 12mo. pp. 84. London, 1832.
supposes an inherent disposition to Highley.
contract in the muscular fibre itself,
a continual exciting cause in the Tuus is an exceedingly instructive es- efflux of nervous influence; and still say, containing the most satisfactory contraction does not take place, unless and conclusive evidence of the effi- further excitement is furnished by a cacy of hot air to the surface of the sudden additional charge of nervous
power.—What an accumulation of act according to its own innate procauses is here!
perties. Is it not more reasonable to How can we, according to this suppose that the nerves occasionally theory, reconcile the anomaly of suspend, than that they only occaspasmodic action taking place, when sionally exert their full influence ? we have evidence of nervous debility And when we are told that muscles co-existing?
are ever ready to contract by virtue of It is a fact, that our best antispas- a principle peculiarly their own, are modics are direct or indirect stimulants we not to suppose
any influence to the nervous system ;-e. g. æther. imparted to them, is for the purpose If muscular contraction depend on of reining in this disposition to act, sudden increased nervous influence, rather than that any additional power is then stimulants would increase the necessary for the performance of an disorder they are intended to act, which experiments prove can go move.
on without such additional power ? How can an animal relax those The nervous influence, then, is immuscles which are without antagonists, parted to muscular fibre, for the purif every property of the muscle itself,
pose of restraining its contraction ; and eyery influence added to it, be for and the action of the will, and of all the purpose of favouring contraction ? other disposers to contraction, is sim
In considering these objections, I ply to withdraw for awhile this influhave been led to imagine that the in- ence, so as to allow the peculiar profluence of the nerves over muscular perty of muscular fibre to shew itself. fibre may be of a nature totally dif- Sir Charles Bell has said, that when ferent to what is generally supposed. a muscle loses all governance of the The opinion I have formed on the nerves, the vis insita falls into partial subject I now beg leave to offer to and general convulsions. Surely your consideration.
then the nature of the governance I will take advantage of the ac- here alluded to, must be to restrain knowledgment that muscular con- contraction. tractility is an inherent function—that This restraining influence is not it is the very nature of muscular fibre derived from the brain; it exists in to shorten itself by contraction. I the extremities of the nerves, even admit too, that this contractility is after they are detached from the regulated by the nerves, and through brain ; their connection with this ortheir medium subjected to the influ- gan is, to admit of the transmission ence of the will, or, as in the instance of volition along the media of conof involuntary muscles, of their pro- nection, the nervous trunks. Thus, a per stimuli.
muscle detached from the body will I cannot allow that the influence contract, but only when particular which is present when the muscle is applications suspend the restraining relaxed, is of the same nature as nervous influence which exists for that which by a sudden influx causes some time after death. In proof of contraction ; I suppose that the ner- this, I may observe, that though cervous influence which is present in tain sedatives applied to a portion of relaxed muscular fibre, is the only in- a nerve, prevent the extremities of Auence which the nerves of volition that nerve being acted on by a power possess over that tissue, that its office applied above the seat of the injury, yet there is, to restrain or controul the they are readily acted on by a power tendency to contract which is inherent applied below it ; so that division of a in the muscle, and that contraction nerve produces paralysis by interruptcan only take place when by an act ing the communication of volition, of the will this iufluence is suspen- not by having its influence on the ded, the muscle being then left to muscular fibre positively destroyed.
this I suppose
According to the theory here attempted to be explained, we have a beautiful provision for contraction, in the innate and independent property of the muscle itself, and another, equally beautiful, to enforce relaxation, in the nervous influence which is superadded to it: thus we are enabled to account for the active dilatation of the auricles of the heart; the blood in the heart causes the nerves to suspend their influence, the muscular parietes of the heart contract, and expel the blood; the nerves are now at liberty to resume their functions, the muscle relaxes from its contraction, and is compelled to an active state of diastole, and the blood again rushes in to supply the vacuum which would other wise be produced.
Perhaps the phenomena of secretion may be accounted for in the following manner:-It has been asserted, that the capillary arteries are furnished along their sides with innumerable foramina, each foramen being provided with a sphincter muscle. Is it not probable that these sphincters are furnished with motory nerves, which are incapable of being acted on except by peculiar substances ? When, there. fore, the matter of the various secretions which is combined with the circulating fluid, comes in contact with the nerves of these little sphincters, they are thereby stimulated to exert their power in producing relaxation, so as to admit that which it is their function to separate from the blood.* Any substance in the blood, which is not of the exact nature of the required secretion, exerts an opposite action on these nerves, causing them to suspend
their functions, so as to permit con-traction of the sphincters, for the exclusion of foreign substances. The action of the lacteals in separating chyle from the contents of the intestines, of the pyloric orifice of the stomach, and of the epiglottis, may be accounted for in the same manner.
I may add another reason which has induced me to adopt this theory, and that is, what is called the tonic contraction of a muscle, as instanced in the stiffened
corpse ; to be nothing more than an uniform exertion of the power of muscular contractility, which takes place over the whole body, when the nervous influence is totally lost, and lasts until the property of contractility is destroyed in the muscles themselves : for the muscles retain their functions longer than the nerves. We find this stiffness comes on gradually, and that is because the nerves lose their power of restraining contraction by degrees.
The nervous system, in well regulated constitutions, is kept in full possession of its properties by the ordinary nutriment of the body; but there are substances which peculiarly excite and increase the power of the nerves, such as spirituous liquors of all kinds, and which, after being persevered in for some time, become absolutely necessary to keep the nerves in full tone; these substances may then be called the food of the nerves.
After a short abstinence from this food of the nerves, the habitual drunkard is unable to regulate the action of his muscles until his nerves are supplied with the peculiar stimulus for which he has caused them to acquire a morbid appetite, and a morbid necessity. The convulsive twitchings of the muscles in delirium tremens, are evidences of an imperfect supply of the nervous restraining influence, and the cause of this is abstinence from their accustomed, and, consequently, necessary food. The most obvious way to relieve this condition, is to break this fast of the nerves, that those properties may be
* It may be objected, that unless their sphincters possessed the power of chemically decomposing the blood, they could not separate fluids which are combined with it ;-but it must be evident, that even mechanical division of a compound substance cannot proceed beyond a certain extent, without eventually separating its component parts by dividing it into its ultimate simple atoms.
restored, which the ordinary nutriment the division of the stricture was at. of the body has been rendered inca- tended by a wound of the intestine: pable of supporting.
A yellowish watery fluid flowed out,
resembling the morbid secretion from I am, Gentlemen,
the serous membrane of the abdomen, Your very obedient servant,
and might be easily accounted for by
referring to the state of irritation proR. UVEDALE WEST.
duced by the hernia ; but the secre
tion, as afterwards appeared, came Jan. 18th, 1832.
from the mucous membrane of the intestines. A ligature was tied round
the wound, and the intestine was reHospital Reports.
turned to the abdomen. After its
disappearance, the operator seemed ST. BARTHOLOMEW'S HOSPITAL.
surprized at finding behind the situaCase of Strangulated Inguinal Her- tion of the protruded intestine, a large nia, in a Patient labouring under Chro- mass of omentum, which was attached nic Arachnitis.-On the morning of by very firm adhesions to the postethe 22d January, about five o'clock, rior surface of the sac. The ordi. Henry Taylor, æt. 45, was brought nary state of entero-epiplocele is— to this Hospital, when it was found, the omentum anterior to the bowel ; after the usual examination, that he and Mr. Lawrence had no recollection was affected with inguinal hernia. of having met with such a case as this The tumour was exceedingly tense- before. A considerable portion of the indeed so much so as to preclude all omentum was removed ; and the vessels hope of reduction by the taxis. The being very large, gave out a copious usual means, of course, were employ- discharge of blood, and a considerable ed for that purpose ; the warm bath, number were tied. The patient was venesection, ice, and tobacco glysters. then put to bed, and allowed to reMr. Lawrence saw the patient at an main quiet for two or three hours, early hour, and deeming the opera- after which he took compound colotion to be indispensable, he recom- cynth pill and sulphate of magnesia, mended the patient to permit it to be at repeated intervals ; but without efdone without delay. But the latter fect. The pain in the abdomen inrefused, observing, that when a simi- creased in the course of the evening ; lar tumour appeared in the same place Leeches were applied in abundance, before, he was fully able to reduce it and purgatives repeated, but no mohimself. At half past twelve o'clock, tion, except the watery secretion alMr. Lawrence visited the ward again, ready mentioned, followed. Next and finding that pain began to be felt morning, he complained of great about the lower part of the abdomen, weakness; the pulse was low, and he urged the immediate performance the surface of the body rather cold. of the operation, and succeeded. Cordials and stimulants were After the sac had been cut into,
ployed without effect, and the pathe convolution of small intestine tient died about one o'clock in the afwhich presented, might measure from ternoon of the 23d, just twenty-four five to seven inches. Its appearance hours after the operation. was generally of a favourable nature, Autopsic Examination.—The apexcept that it was somewhat preterna- pearance of the membrane lining the turally reddened. In consequence of cavity of the abdomen was genethe employment of a very small and rally healthy, but on the side where shallow director, which proved quite the hernia occurred there was a slight insufficient for the necessary degree increase of redness on the convoluof protection to the surrounding parts, tion of the intestines. The state of