Imágenes de páginas

In some cases, when given even in very small doses, it reduces the frequency of the pulse, renders the expectoration easy, and alters the nature of the matter expectorated. In others, it seems rather to increase than moderate the quickness of the circulation. In that form of pulmonary consumption which is preceded by hæmoptysis, of all internal medicines, I consider it the most useful. În strumous constitutions it is less frequently beneficial ; but no practitioner can have given it an extensive trial without being convinced of its occasional value. As an expectorant, we find digitalis recommended in some of the old herbals; and that it was a popular remedy for consumption, long before it came into fashion among medical men, is evident by the manner in which it is mentioned by that extraordinary character John Wesley, in his Primitive Physic.” p. 103.

Dr. Southey speaks favourably of issues in the side af. fected; of regulated temperature, and of the tepid bath, He also quotes several passages to prove the efficacy of gestation in this complaint, and instances the case of the Tate Dr. Currie of Liverpool, whose life was, it appears, saved by passive exercise and change of scene.

The volume concludes with a refutation, as Dr. S. thinks, of Dr. Wells's hypothesis respecting agues and consumption, and on this point we have already hinted our sentiments. If the perusal of the work has afforded us less profit than amusement, it is probably owing to the nature of the subject, rather than to any deficiency on the part . of the author. Yet we can scarcely divine the reason why Dr. Southey should take the trouble of writing and printing what has been written and printed fifty times before ; unless he considers the adjunct of author as essentially necessary to that of practitioner, and consequently, that even a poor book is better than none at all. Our cynical habits of criticism may have rendered us too fastidious; but with Dr. Southey's abilities, we should have aimed at something original and interesting, or else have “ kept the noiseless tevor of our way," without attempting to snatch a inomentary respite from that oblivion, wbicb, sooner or later, must annihilate every vestige of human learning and ingenuity!


The Morbid Anatomy of the Brain in Mania and Hydro

phobia; with the Pathology of these two Diseases, as col· lected from the Papers of the late ANDREW MARSHAL,

M.D. many Years Teacher of Anatomy in London ; with an Account of some Experiments to ascertain whether the Pericardium and Ventricles of the Brain contain Water in a State of Health. To which is prefired a Sketch of his Life. By S. SAWREY, Member of the Royal Col. lege of Surgeons, formerly. Assistant Lectorer to Dr.

Marshal. London, 1815. 8vo. pp. 294. It always affords us real pleasure when we see the profes. sors of Medicine sedulously turn their attention towards the investigation of Pathological Science, and employ themselves in endeavouring to discover and ascertain valuable and important practical facts, in preference to wasting their time and talents in the barren and unprofitable speculation of framing ingenious but erroneous hypotheses, destitute of a sufficiently stable foundation of indisputable principles whereon to raise a permanent superstructure. The fruits of a long life thus honourably spent, however satisfactory to the zealous cultivator himself, or beneficial in their application to the purposes of practical medicine, will generally make but an inconsiderable display of bulk in the library of the Physician, compared to the productions of an excursive imagination indulging itself in wild irregular flights of inventive genius. Yet on this basis alone must the perfection of medical science ultimately rest; an object requiring the united efforts of ages for its completion. Of how small avail in general the labours of an individual, although judiciously directed and diligently prosecuted, are to the advancement of medical science, we have an instance in the work before us, which although it evices much acuteness of research in the author, and displays in a clear and intelligent manner the results of faithful observation, has thrown but little if any additional light on the intricate subjects which form the contents of this volume. As an anatomist, Dr. Marshal enjoyed con. siderable reputation, and the prosecution of his favourite pursuit must frequently have furnished him with opportunities of deciding doubtful points in physiology, and of correcting erroneous opinions in pathological science; we, therefore, propose to consider the observations here offered as the result of his experience, with a great degree of attention.

The first question agitated by the author is, whether water is contained in the pericardium or ventricles of the brain in their healthy and natural state, or whether it be not always an effect and evidence of disease? The former opinion was entertained by the late John Hunter, as well as by several other eminent anatomists, among whom are Lower and Haller; whilst Dr. Marshal contended, that no Auid exists within these membranes in their healthy state, and that its presence there, in however small a quantity, was incompatible with their healthy functions, and he instituted some experiments to ascertain this point. In several animals destroyed whilst in perfect health, and subsequently examined for this purpose, no water, even in the smallest quantity, was discoverd in these membranes. The author concludes therefore, that nothing more than a moist. vapour is effused into the cavities to lubricate the surfaces, which is removed by the lymphatics as it forms, or is con, densed into water. We believe this is the opinion at present entertained by the most respectable physiologists of this country, and that pathologists in general will agree with Dr. Marshal, that the first formed drop of water in the pericardium is the beginning of the disease hydrops pericardii. When, however, water is found in these cavities after death, we are not always to conclude, that a state of disease existed for any length of time during the life of the animal; for it appears, that under peculiar circumstances, water may be thrown out by the exhalants, in a very short period of time, into these as well as other cavities, even soinetimes while the animal might be said to be dying. After drowning, for instance, where vascular action is not so speedily stopped as when the animal is more quickly destroyed, water is frequently found not only in the pericardium, but also in the pleura. This circumstance Dr. M. ascertained by some experiments instituted for the purpose; the fuid found in these cavities was thrown out by the exhalants in the act of dying, in consequence of the peculiar state in which the heart and arteries were placed by drowning, and must not be considered as having existed during the life of the animal; so that the result of these experiments rather strengthened, than militated against the author's conclusion, that “the presence of water in these parts is, in all cases, an indication of disease.”

Another interesting subject of enquiry discussed at some length in this volume, is that of canine madness; and we are here presented with two cases of that disease, related with some degree of minuteness, and the appearances on.

No. 54.


dissection of both the subjects are faithfully detailed. The symptoms of this melancholy disease are now familiar to most medical men, and the state of parts after death has been frequently inspected. We are far, however, from having arrived at any certain pathological principles of the disease, nur have we attained any successful mode for its treatment. The author's view of the pathology of this disease is in some respects novel, and deserving of attentention. He divides the disease, after its actual commencement, into two stages; the first, one of great and universal irritation, and the second, the proper maniacal state. We shall give some extracts from this part of the work, that our readers may be put more fully into possession of the sentiments of the author.

After noticing the first appearance of local affection, viz. pain and uneasiness in the bitten part, and the consequent effect upon the contiguous vessels, the author thus proceeds :

* About this time, which I have already called the first stage of the disease, that the irritation and pain broke out in the band and arm, the heart began to be affected with corresponding irri. tation.. I know not all the little invisible steps by which the irritation reached the beart; whether it was by the irritation extending to the larger blood-vessels of the arm, and from thence to the heart, or by the transmission of the poison through the lymphatics; but about this time the action of the heart became quicker, and more frequent; and the irritation spread to the whole arterial system. The dilatation of the arteries became every where accelerated ; and their alternate contracti@as were performed with corresponding celerity. And there can be no doubt, that the great veins terminating in the heart, were also irritated and made quicker in their contractions. Another alteration seems to have been produced along with this general irritation in the sanguiferous system; the heart, large arteries, and veins became permanently smaller in size. We conclude, that the heart became smaller and firmer, because the dilatations of the arteries, in their rapid series of action, were minuter and harder; -we infer, that ibe. arteries became smaller and firmer, for the same reason, and because in their state of contractility they correspond to that of the heart ; we presume, that the veins were smaller, because, notwithstanding the rapid circulation, the subcutaneous veids arose to no turgescence. The dissections, as well as the symptoms evince, that the capacity of the sanguiferous system was diminished; the heart, in both, being found unusually cootracted and hard ; the great arteries unusually diminished in capacity; and the great veins of the neck so small, as to be taken for arteries in point of size." .

The state of congestion in various parts, is thus satis

factorily accounted for; this state of congestion and repletion is evidently an effect among others of one common cause, and does not by any means constitute the essence of the disease. The author further observes, that

". The morbid contraction, which pervaded the sanguiferous system, extended into all the membranous structures of the body; operating in some more, in others less. · The lungs seemed to be first affected with it; the air vessels in general becoming a little contracted, which caused a slight tightness in the breast, and of fering a slight obstacle to respiration. This morbid contraction soon followed in other parts. The stomach was contracted a little; which sometimes produced vomiting. From the inactivity of the intestines, taken in connection with the failure of appetite, there is reason to conclude, that the intestines were partaking of the same disorder."- " The general tightness it would seem was owing, in musculo-membranous parts, to an increase of contractility in the muscular parts, joined with an increase of elasticity in the other component membranes; in the membranes, not moved by any muscular fibres, it was owing merely to the increase of the elastic powers of the parts. What change such a general contraction in parts so important in the constitution produced in the feelings of the patients, is unknown. Being general, and probably equable, it caused no acute pain; but whether we reflect on this state of living paris, or on the sad and distressed looks of the patients, we must admit that their feelings were extremely miser. able."

The delicate structure of those parts concerned in performing the office of deglutition, and the nice co-operation of muscular actions requisite for the performance of the act of swallowing, render the effects of this universal contraction eminently conspicuous in the interruption of this important function.

“ When deglutition,” says the author, “comes to be performed by such a state of parts as has been noticed in the disease in question, it is experienced to be impracticable, and the attempt is dangerous. Every time the larynx is elevated for swallowing, the glottis is violently contracted, precluding the air too long, while the mouth of the pharynx shuis against the morsel. The person is thrown into instant agitations, just as if seized by the throat; for not only does he experience sudden strangling, but an insurmountable obstacle in the pharynx."

The duration of this universal state of contraction previous to the commencement of the madness, varies in different persons ; in all of them, however, it at length takes place; by continuance of the morbid contraction, the arteries of the head become far more irritated than any other arteries in the body, determining the blood in an over proportion to the brain, at the same time the jugular

« AnteriorContinuar »