not boast, the French school is now a powerful rival to any that we can produce. Some of the best works upon anatomy, physiology, practical medicine, and chemistry, have issued from it. French physicians are emulous to cultivate general science, and are encouraged by honors, titles, and adequate remuneration for their labors, to assume that high rank in society which becomes their profession. The curious experimenter, besides the gratification of adding to the general stock of knowledge, obtains the notice of the world by his researches being recorded in the Memoirs of the Imperial Institute; chemistry opens a certain channel to rank and wealth; the great demand for skilful surgeons in an army constantly inspected by its active chief, insures their production; while peaceable men, disgusted with continued bloodshed and rapine, honor and esteem physicians whose labors tend to correct the evils and afflictions incident to human nature, and fearfully augmented by the ambition or the folly of rulers,

1

"Quales ex humili magna ad fastigia rerum Extollit, quoties voluit fortuna jocari." The first disease noticed by our author is Pericarditis, which he regards as an inflammation of the whole or of a part of the serous membrane which immediately invests and closely adheres to the heart in every part, and furnishes the loose bag in which it is contained. It appears in two forms, acute and chronic. Acute inflammation of the pericardium is not always easily distinguished. "Pleuripneumonia is generally complicated with it, and it is frequently very difficult to say which first appeared, or whether their commencement was not simultaneous.' The author confesses he has not met

with a pure case of acute pericarditis; of course, those which he cites are more or less complicated with other diseases; but as these appear to be chiefly pleuritis, peripneumonia, Paraphrenitis, it is of less consequence, as the only hope of cure in either of them, pure or combined, must rest on early and copious bleeding.

and

The author has described a variety of the disease under the term sub-pericarditis, a case of which we here insert.

65

On the 9th of January, 1799, a man, aged forty years, received a blow by the fist on the region of the heart. On the 25th of the same month, violent febrile symptoms, accompanied by oppression Pain under the left part of the sternum, suddenly took place:

and

during the three first days these symptoms increased so much, that on the 30th he made up his mind to become a patient in the Clinical Ward of the Hospital; the best marked inflammatory symptoms had then disappeared without any visible advantage: he complained only slight pain in the head, and a continual and indescribable anxiety,

of a

which left him not a moment's ease; the skin was dry and hot, the pulse small, frequent, unequal, intermittent, and irregular; the eyes were sunk; the features much changed; the left cheek was very red; the mouth tolerably clean. The sound, by percussion, was very obscure throughout the left side. The breathing, apparently easy, was, nevertheless, on close observation, short, frequent, and a little interrupted; the cough dry and not painful; the patient, notwithstanding, complained of a pain which extended from the posterior part of the sternum to the left side, and to the lower part of the right side of the chest; there were momentary sinkings, which did not amount to fainting. The stools were few, the urine was turbid and deposited a sediment. On the first day I ordered one bleeding; but I did not persevere in this plan, on account of the advanced stage of the disease. From the 30th of January, it was evident that the disease made a rapid progress; the countenance became more and more hippocratic; the patient had not a moment's quiet; the breathing was continually interrupted and very difficult; the pulse vacillating, and scarcely perceptible; the prostration of strength extreme, notwithstanding the use of cordials. He remained in this state for the ten first days he was in the hospital; the only remarkable phenomenon during that time, was a spontaneous and almost sudden dissolution of the right eye, from a suppuration which took place in it without being preceded or attended by any inflammatory symptoms. After these ten days, the disease appeared still to advance more rapidly. The features became entirely changed, the pulse imperceptible, the debility extreme, even unto fainting. This patient finally sunk on the nineteenth day of his admission into the hospital, and on the twentyfourth of his disease.

"I sought in the cranium the cause of the sudden destruction of the right eye; but the brain, the thalami nervorum opticorum, and the optic nerves themselves were perfectly sound.

"The pericardium was so enormously enlarged as to contain near four pints of seropurulent fluid; its inner surface was throughout covered with a thick crust of albuminous matter, the superficies of which was reticulated and curdled; an appearance of which one cannot give a better idea, than by comparing it to the inner surface of the bonnet, or second stomach of a calf, except that, in this case, the depth of this kind of net-work was not so great.

The

"The heart was not altered in size; but the leaf of the pericardium which covers it, was firmer and more than two lines thick. fleshy fibres were not sensibly altered. The left lung, pushed upwards, was spongy and crepitous; the right lung was sound.

"That part of the diaphragm which unites with the pericardium was not inflamed."

The author attributes the freedom from complication in this case, to the exciting cause being external and circumscribed. He also thinks that if antiphlogistic means had been actively employed in the beginning, they might have moderated, and perhaps subdued, the inflammation.

The chronic form of pericarditis is complicated and ob

scure,

scare, and Corvisart has afforded us no additional knowledge upon the subject. The treatment he recommends in all forms of the complaint, is such as is most generally pursued by sensible practitioners.

Adhesion of the pericardium to the heart, is a frequent consequence of pericarditis; from whatever cause it is produced, Corvisart states that it may take place in three ways. 1. From interposition of the lymphatic exudation thrown out by the inflamed pericardium. 2d. From rheumatic and gouty affections. 3d. "It is sometimes owing to numerous cellular filaments, the length of which varies from seven or eight lines to the smallest possible.' "The adhesion of the pericardium to the heart, in this last case, and sometimes in the second, does not constitute a real disease; it merely puts the patient into a state of insupportable inconvenience. 22 In partial adhesion the function of the heart is not sensibly injured; but when the adhesion is complete, the author thinks that death must inevitably take place, though not immediately. The following is a case in point:

reason

"A man, forty years of age, felt a very violent pain in the epigastric region. This pain was accompanied by weak but frequent palpitations, and great difficulty in breathing. The pulse was small, quick, and irregular; and on applying the hand to the region of the heart, it appeared to beat with irregularity. From time to time the pain, the difficulty of breathing, the palpitations, and indeed all the symptoms, were greatly aggravated. In one of these paroxysms, which occurred after short intervals, an ecchymosis took place about the eye-lids of the right eye, the ball of which became inflamed. "Although the number and severity of these symptoms gave great to fear for the life of the patient, he was, nevertheless, enabled by the antiphlogistic treatment, and the use of emollients and antispasmodics, to resume his usual occupations. He continued in health for forty days, when he became a patient in the Clinical Ward. To the symptoms before described, were now added ascites, and frequent paroxysms of fever. The quantity of water was so great as to render tapping necessary, but this was employed only as a palliative; in effect, the water again collected; the patient complained of continual pains in various parts of the belly, but principally at the bottom of the right iliac region. The pulse was constantly very weak, the sleep trifling, and the left side of the chest did not sound on percusThe strength diminished daily, notwithstanding the use of

sion.

cordials. In fine, eight months after the first illness which I have mentioned, the patient passed quietly from life to death, a few minutes after he had gone to bed, where he was thought to be sleeping. In the course of this person's first complaint, I had announced the existence of an organic lesion of the heart. My diagnostic beprecise long before his death, and I thought I could pronounce that there was an adhesion of the pericardium to that viscus. On opening the body I found a considerable quantity of water in the

came more

No. 174.

left

left cavity of the chest; the pericardium adhered externally to the lungs, and internally to the heart, its adhesion to which was so strong, that they could not be separated without a most careful dissection. The blood was accumulated in the right cavities of the heart and in the vena cave, so as to distend them to an extraordinary size; the other parts of this organ were in a natural state. The blood, in all these cavities, had a remarkable fluidity. The muscular fibres of the heart were generally very pale, and their action must have been reduced to almost nothing for some time before death, which, perhaps, may have been the immediate cause of that event. The left lung, pushed up towards the superior part of the chest, was hardened; the right was in a tolerably good state.

"The cavity of the abdomen contained a good deal of bloody serum; the alimentary canal was contracted, and altered externally; almost the whole of the peritoneum was covered with granulations."

Besides the symptoms already detailed, in some cases of adhesion of the pericardium others have been frequently observed. In many instances, sudden flushing of the countenance; a painful sensation of pulling in the region of the heart; the breathing quick, and oppressed on the slightest motion, and faintings; with a pulse more or less irregular. In distinguishing this complaint from other affections of the organ, the author places great confidence in the absence of palpitation; for how, he asks, can the heart, when closely connected with the diaphragm by its membranous covering, perform violent and tumultuous movement, all change of position being nearly prevented by the adhesion? The

contractions of the heart are, in this case, quick and disordered, but dull and deep, weak, obscure, and imperfect." The complaint, however, is always difficult to be ascertained, especially when combined with other affections of the heart or chest; and complete adhesion has been discovered by dissection, when during life such an affection was not indicated by a single symptom.

Among several cases cited by the author to illustrate this disease, is one of an apothecary's assistant, who had long appeared dejected, and at length committed suicide. In this case the pericardium had formed adhesions for the space of about two inches in diameter round the apex of the heart, which appeared of long standing.

Chapter II. on Hydro-pericardium, though not devoid of interest, does not claim our peculiar attention.

In the Second Class, which treats of diseases of the muscular substance of the heart, Aneurism, which is here synonymous with dilatation of the heart, holds a conspicuous rank, and occupies much space; we shall however pass it over in our analysis, because, from the labors of our own surgeons and anatomists, we are perhaps better acquainted with this

than

than some other diseases of the organ which we shall have occasion to notice,

In the fourth chapter, upon Induration of the muscular Tissue of the Heart, some interesting cases are detailed. We extract one from section 2. “Of the Conversion of the muscular Tissue of the Heart into a cartilaginous or osseous Substance."

"A man, aged 64 years, had always enjoyed good health until the beginning of the summer of 1798. At this time he was attacked with a disease of the chest, for which he was bled seven times, and which, on his recovery, left him in a state of the greatest debility.

"Fourteen months after the cure of this acute disease, he was seized with difficulty of breathing, with violent stiflings, which had existed for about two months when he came into the Hospital. Six days before his entrance, the stiflings had become so violent, that, on the slightest motion, he was in danger of suffocation. He said he had not had palpitations. His pulse, scarcely perceptible in either wrist, was small, concentrated, and irregularly intermittent; it might be said to be suspended for two or three pulsations: on placing the hand on the region of the heart, it was felt to beat with great violence, which by no means corresponded with the state of the pulse. The chest sounded well, except in this region and towards the posterior and right side of that cavity, which had been the seat of the peripneumony. The legs were rather clammy than oedematous. He often awoke from sleep with starting.

Though convinced of the existence of an organic lesion of the heart, I felt much difficulty in deciding upon its nature. I was most disposed to consider it as an aneurism of that organ, complicated with the contraction of some aperture.

"The prognostic appeared to me of the most melancholy kind. However, diuretics procured sensible relief for two months. The breathing became easier, the pulse more free and regular, and less intermittent; but towards the beginning of April, 1800, he became worse than ever. The pulse resumed its old characters. The breathing became suffocating, and the urine less in quantity. The legs again began to swell. The cedema made an alarming progress in a short time, and the patient died without agony on the 17th of April, eighteen months after the disease of the chest, and two months after his admission into the Hospital.

"At the time of opening the body, the face, and particularly the lips, were of a violet and blackish color.

"The lungs, in other respects sound, had contracted slight adhesions to the costal pleura.

"The size of the heart was much greater than usual,

"The right auricle and ventricle were much expanded, and their communicating aperture was evidently in a state of dilatation. The left auricle, too, was very large, and its aperture of communication dilated; the mitral valves were become cartilaginous.

"The sides of the left ventricle were at least an inch thick, and very solid; the apex of the heart to a certain height and throughout

V 2

its