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has been directed to the subject, upon those forms of disease or organic lesion of the heart, which do not come under the two preceding sections; briefly noting all the more isstructive and clearly-marked cases which have fallen under my notice. To these, allusions have frequently been made in the late Numbers of this Journal.

Corvisart, in his inestimable work on the pathology of the heart, declares it as his opinion, that this organ, the lungs excepted, is more frequently diseased than any other of the human system. His extensive experience, and capability of deciding upon such a question, could, not be doubted; yet I felt greatly disposed to suspect the accuracy of a statement, thus novel and unlooked for; not attributing, however, the erroneous calculation to any wilful deviation from truth, but to the enthusiasm of an ardent mind employed upon a favourite topic of inquiry. Time and reflection, and farther opportunities of observation, have served only to confirm the accuracy of the estimate formed by the celebrated Frenchman. Within the last ten months, I have witnessed twenty-four fatal cases of disease. From these I have obtained leave to make five dissections: in three, the heart was found greatly diseased in structure. Two of the others would, I am persuaded, from the striking character and assemblage of the attendant symptoms, have afforded similar results, had the opportunity of examination been allowed me. These twenty-four cases include six of pulmonary consumption.

That the human heart should be so frequently the seat of disease will appear no longer mysterious, when we reflect that every vivid or powerful emotion of the mind,all continued or inordinate exertion of the physical energies, must inflict a corresponding trouble and disorder upon its functions. The flushed cheek of rage, the pallid

* See the motto prefixed to this introduction.

† One of these cases was enumerated in our last December number. The two others, one examined in February, the other in March, will be noticed in the two first sections of this Memoir,

hue of terror, the breathlessness and palpitation of extraordinary muscular efforts, constitute some of the most familiar examples of this liability of the heart to accelerated or disordered action. We might multiply them, but it would be useless. Be it also recollected, that the heart exquisitely sympathizes with, or is very frequently affected by, the various lesions or derangements of other important organs, contiguously or more remotely situated. The lungs, the diaphragm, the liver, the stomach or the spleen, cannot be severely affected by inflammation or other morbid change, but the heart or its appendages are directly or consecutively implicated. Can we then wonder, that in an organ thus constituted and connected, thus exposed to the influence of every gust of feeling, every transport of passion, every impulse of muscular exertion, derangement should be common; that in such a soil, if the expression may be allowed, the seeds of organic disease should germinate with such rapidity and luxuriance?

The developement of diseases of the heart must also be signally favoured by the gloomy and eventful character of the present times. In proportion as nations emerge from rudeness and barbarism to civilization and refinement, in that proportion are its artificial wants and indulgences multiplied, luxury introduced, and the empire and influ ence of disease extended and diffused: in proportion as the simplicity and repose of early pastoral habits are exchanged for the enterprise and distractions of commerce, or the toil and tumult of arms, so are aroused into action all the darkest cares and wildest passions that can prey upon or convulse the human breast. Hence, perhaps, the increasing frequency of diseases of the heart in this island will admit of explanation. Corvisart remarks, that he found them unusually common in France, during the tempestuous period of her ever-memorable revolution.

Five years have elapsed since some vexatious and unexpected occurrences in practice first aroused my attention to this interesting class of diseases. I beheld, on the death-bed of one or two of my patients suffering from

obscure thoracic diseases, symptoms which I could neither unravel nor comprehend. Fearful palpitations of the heart, dyspnoea, intermitting pulse, now and then obtruded themselves on my view in maladies which I had been taught to consider as nervous or dyspeptic. I saw alarming, and in one case fatal, symptoms of apparent debility come on upon the sudden retrocession of rheu matic inflammation of the joints. Patients who had been cured of diseased liver by mercury remained feeble, emaciated, and desponding: many, to whom diuretics bad been successfully administered against dropsical effusions in the cellular membrane and abdominal or thoracic cavities, languished for a few months in a deplorable state; or were subsequently cut off in an abrupt and mysterious manner. My mind was forcibly struck by these occurrences. Mr. Allan Burn's work was the only one, professedly written on the pathology of the heart, with which I was then acquainted. Excellent as it is, I did not derive from it all the instruction of which I stood in need; and I had little leisure for extended literary research. At this time I gleaned, from the practice and conversation of a neighbouring physician, some important accessions of knowledge. He alone, within the sphere of my personal intercourse, entered with ardour upon the subject in which my mind was so deeply interested. To his liberal and masterly suggestions I shall ever consider myself deeply indebted; and I embrace with pleasure this opportunity of publicly acknowledging the obligation. To Doctor EDWARD JOHNSTONE, of BIRMINGHAM, I beg leave, therefore, to inscribe this Memoir. A dedication of this trifle to a name thus respectable may be deemed ill timed and extraordinary; but one surely may be allowed to deviate, uncensured, from the ordinary track, where the payment of a long-accumulated debt of gratitude is the object. I propose that the commencement of the Memoir shall appear in the next ensuing Number of our Journal. In the mean time, I shall present to my readers some highly interesting cases and dissections of cardiac disease from the French of Mérat, in a concise form; and a most valuable

communication upon the same subject, with which I have recently been favoured by William Birch, Esq. Surgeon, of Barton-under-Needwood, in this county.

HISTORIES AND DISSECTIONS,

From the French of Mérat,

1. Case of Adhesion of the Pericardium to the Heart, with active Aneurism of the Left or Aortic Ventricle. Detail of morbid appearances. The body extremely emaciated. The lungs sound and without adhesion. The heart at least thrice its natural size, and occupying a great part of the anterior region of the thorax. The aortic ventricle particularly enlarged. All the valves, and the large arteries at their origin from the heart, in the na tural state. The pericardium universally and closely adherent to the heart, by means of a cellular structure of recent formation; the membrane itself red, and exhibiting traces of inflammation. The viscera of the abdomen quite sound.

History of symptoms.-Disordered respiration, succeeded, after a time, by fever, pain in the left side of the thorax, and bloody expectoration, of a month's continuance. Shortness of breathing and frequent pulse, manifest during apparent convalescence. Six months after this attack, a slight relapse with pain in the side, and increased difficulty of respiration and velocity of pulse. Yet the ordinary amusements and occupations were pursued. Three months after the second paroxysm, another relapse. The countenance now pallid; the lips of a violet hue; the heart beating with uncommon force and tumult, and the pulse sharing its agitation. No cough or pain; the tongue clean; yet the stomach rejecting its contents during the two or three first days. On the third day, respiration more difficult; occasional strong efforts to inspire; slight cough and puriform expectoration. During sleep, the whole thorax and part of the abdomen very sensibly elevated by the palpitation of the heart. The carotid and subclavian arteries throbbing violently; the pulse extremely rapid. Respiration more difficult on

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the sixth day. Death, after a slight struggle, upon the seventh. There had been no fainting. The intellect remained unclouded to the last. The subject of this case was a thin, delicately-formed lad, of twelve years; unhealthy; much addicted to study; but irascible, and fond of the amusements of his age.

Mérat thinks that, in this case, the aneurism of the heart was of very long standing, and not sufficiently advanced to destroy life. The fatal event was, in his opinion, determined by the acute inflammation of the pericardium.

2 Case of passive Aneurism of the Right or Pulmonary Cavities of the Heart.

Detail of morbid appearances.-The body universally oedematous. The lungs filled with yellow serum, and exhibiting traces of a false organized membrane, consequent upon inflammation, of an old date. The heart double its ordinary volume; the pulmonary auricle much dilated, thin in its parietes, and gorged with coagulated blood; the corresponding auriculo-ventricular orifice greatly enlarged; the ventricle itself dilated, and its muscular walls extenuated; the parietes of the aortic ventricle thickened, but its capacity natural; as were the large vessels at their origin.

History of symptoms.-Sense of oppression, aggravated by exercise; the recumbent posture quite easy, but the sleep disturbed; cough; unhealthy expectoration; after the lapse of a fortnight, suffocations with inordinate ac. tion of the heart, coming on by paroxysms, especially during the night, and mitigated or removed upon a return of the expectoration; the oppression and cough increasing; œdema of the inferior extremities; reclining upon the right side or back afterwards difficult; the pulsations of the heart quick, tumultuous, feeble; scarcely percepti ble in inspiration or expiration. In placing the hand upon the region of the heart during the former, a sort of tre mor distinguished, apparently ascending along the middle and posterior part of the sternum. The affection, of ten weeks duration, presenting towards its close the same symptoms with increased violence. The pulse becoming

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