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m srmHar cases. Although the symptoms were exceedingly obscure, I had an idea that they mi^ht arise from an affection of the heart. The smallness, weakness, irregularity, and peculiarity of the pulse, gave rise to this idea. This patient died; and I found, on opening the body, the pericardium much distended with a lactescent and puriform liquid. The heart was whitish, small, as if retracted, without consistence, and quite misshapen. The auricles, ventricles, and great vessels, were surrounded by a white lymphatic substance.
"This woman had been ill for seven or eight months; but the true nature of her complaint had never been suspected: yet the appearances, on opening the body, left no doubt of the early existence of carditis, which had degenerated into chronic inflammation of the heart, the symptoms of which were obscured by the dropsy, consecutive, doubtless, upon the affection of that organ."
Acute carditis, according to Corvisart's own experience, never occurs without complication; but he does not appear to have seen many instances of the disease. It may terminate by suppuration, by gangrene, and by ulcers.
The second section treats of Rupture of the Heart. This accident may be either complete or partial: in the one case, the parietes from the interior to the exterior surface burst, and the blood is effused into the cavity of the pericardium; in the other, only a portion of the substance of the heart is affected. Complete rupture of the heart is a rare event: the ingenious translator has reminded us that George the Second died of this complaint, and has given Dr. Smollett's concise account of the circumstance. Under partial rupture of the heart, the author includes the rupture of one of the carnese columns, on the internal surface of the ventricles; and " the rupture of the chorda: tendineae,which, rising from those pillars, are attached to the floating extre'mities of the Valves." This affection has been noticed, and the probability of its occurrence testified by Haller, Morgagni, Senac, and other writers; but verv few cases of it have been recorded, and none so distinctly as those related by Corvisart.
"A man, aged 20 years, of a vigorous constitution, was admitted into the Hospital of la Charite, at an early period of the French revolution. For some time he had quitted a sedentary trade to become a messenger: devoted to this very laborious life, he travelled incessantly to every court in Europe. When he came into the hospital, he had been travelling a thousand leagues on horseback, without taking repose: he bad, besides, taken a journey from London to Paris; and, in passing from Dover to Calais, he had experienced, for the first time, difficulty in breathing, and a spitting of blood; having, notwithstanding these symptoms, continued his journey, the disease had much increased, and by the time he lwd reached Paris, was accompanied by pain in the chest.. He had been bled five times during the three days he had kept at home, but finding no relief from the bleed
No. 174. . • x iugs ings and other treatment which had been deemed necessary, he came to the hospital eight days afte"r the commencement of the disease.
"The features of the face were then much altered, and the extremities slightly cedematous; the pulse was small, hard, very frequent, and rather irregular. On ,applying the hand to the region of the hear!j besides the very strong pulsations of that organ, confused and irregular beatings were felt, not at all resembling its natural movements. The patient could not continue long lying, standing, or sitting, and was in a state of anxiety and agitation not to be described. "His legs and thighs swelled the day alter his entrance, and his features became still more changed. During the following night, the symptoms increased: he was dreadfully agitated, walking into the other wards, sitting down, incessantly rising, but still preserving his mental faculties. The sense of suffocation now becoming highly alarming, this unfortunate man was convinced of the danger of his situation, and abandoned himself to the most violent despair: he died, testifying by all his gestures the regret he felt at quitting life.
"I repeated, before I opened the body, what I had announced on the first day, that there existed in this patient an acute lesion of the heart, and probably a rupture or laceration of some part of it.
"The left lung was sound; the right had contracted slight adhesions to the costal pleura; its upper lobe was very firm, but without tubercles; in the ridges which separate the different lobes, there was a lymphatic coat, produced by the consecutive inflammation of which this organ had evidently been the seat. There was a quantity of water in the chest.
"The pericardium contained about half a pint of yellowish serum; The heart had not acquired an extraordinary size. One of the large columnse which support the mitral valves of the left ventricle, had ruptured at its base, so that it floated loosely in that cavity; there ■was an appearance of suppuration at that point of the heart where the rupture had occurred, proving that it was not of long standing. Near the rent there was a clot of blood covered with purulent matter, which came from the torn part."
"A turner, aged 31 years, of a strong constitution, and of an irritable and violent temper, gave himself, in endeavouring to move a tun of brandy, to use his own words, a twist of the reins, which immediately caused a sense of suffocation and an acute pain between the shoulders: soon afterwards, cough, palpitations of the heart, and frequent startings in his sleep, took place. These alarming symptoms, far,from yielding to the remedies used, and becoming every day worse, he went to the Hospital of la Charile, where, during his first residence, he received much relief. He quitted it, but returned in four months, when nearly two years had elapsed since the violent exertion which appeared to have produced the disease.
"On the 21th of March, 1803, the day on which he came'into the Clinical Ward, this patient was in a state of extreme anxiety; his breathing was suffocative; and he felt acute pains in the region of the heart, which forced him to cry out, particularly during the night. He died in two days.
"On opening the body, I found, in the right cavity of the chest,
four Four pints of serum. The lungs of this side were sound. The left thoracic cavity contained but little water.
"On the fore part of the mediastinum there was a small purulent spot of the size of a sixpence, without any alteration of the cartilage of that side, to which this kind of ulceration corresponded. Tho heart, wilh its capsule, was three times its natural size.
"On the exterior surface of the pericardium, there were a number of excrescences, shaped like a cock's-comb, pale and livid at the base, but of a deep red at their summit: they were nothing but portions of fat which had undergone a peculiar kind of change. This membranous capsule adhered to the heart by means of a firm fatty substance.
"All the cavities of the heart were dilated, and contained much black and coagulated blood.
"The right auricle was so much dilated, that its auricular appendix had entirely disappeared; the right auriculo-ventricular aperture was also much dilated, and the ventricle slightly so; the tricuspid valves, and those of the pulmonary artery, were in a good state.'
"The left auricle and ventricle had much increased in volume. The parietes of the ventricle were thickened, and the mitral valves studded with several soft and fleshy-like excrescences.
"On examining the tendons of the fleshy pillars which support these valves, two of them appeared to have been ruptured for some time. Their extremities were soft, smooth, and rounded at the ruptured part. The precise point of the edge of the valves to which they had been attached, could not be discerned.
"The valves of the aorta were not altered, but this artery was itself dilated at the beginning of its arch.
"There was some water in the abdomen; the viscera of this cavity were sound."
The third Sectionf upon Tumors of the Heart and other unnatural States of that Organ, contains some valuable and interesting facts both from the author's own experience and that of other writers. The following case of Perforation of the Septum of the Ventricles is very curious, and deserving of attention.
"A child, aged 12 years and an half, was admitted, on the 21st of April, 1797, into the Clinical Ward. He was then in so dreadful a state, that there was reason to think he could not live many days. His complaint, according to his own account, had not existed for more than five months; but, from the violent and repeated palpitations which he had always experienced, it was not unreasonable to suppose, that the disease was of much longer date. . .
"When this boy was admitted into the Hospital, his face was bloated and his lips were violet; there was no cedema in either the upper or lower extremities; the respiration was much impeded; the hand, placed upon the region of the heart, felt an irregular beating, accompanied by a very remarkable rustling. The pulse was, nevertheless, very regular, but small, weak, and easily suppressed, The palpitations were frequent, and came by paroxysms, accompanied by
j 2 threatening threatening suffocation. The patient could not lie down: he was better when sitting upright, and still more so when inclining forward. He made water frequently, and in proper quantity.
"During his short stay at the hospital, his disease made an alarming progress. He was put under a course of diuretics and powerful antispasmodics, but they procured, as had been foreseen, no relief.
"On the 24th he had a fit of suffocation, stronger than any which had preceded it, and which threatened to terminate his existence ;• but this paroxysm went off, and the patient, some moments after, found himself better than he had been for a long time. However, more alarming symptoms soon returned, and he died on the 25th, after an agony of from ten to twelve hours, during which his body was covered with a cold sweat, and a yellowish froth dribbled from his mouth,
"On opening his body, the lungs, except being rather flabby, were in a healthy state. The pericardium contained a small quantity of water. ./
"The heart was much enlarged, and appeared rather to belong to a large and full-grown man, than to so young a child. There was nothing remarkable in the auricles but their increased size.
"The parietes of the right ventricle were thicker than usual. The septum had preserved its natural thickness, but there was a round hole in it, near the spot where the pulmonary artery takes its rise, large enough to admit the extremity of the little finger. This opening communicated with the cavity of the left ventricle; its edges were smooth and whitish throughout. At the upper part of the margin of this aperture, there were two little fleshy tubercles, of a reddish color.
"The parietes of the left ventricle had preserved their natural thickness. In the cavity of this ventricle, just below one of the sigmoid valves of the aorta, the opening of the hole I have been speaking of, could be perceived. The aortic semi-lunar valve, beneath which it was situated, was corroded, and in part destroyed. It formed a kind of little fringe, which presented itself at the orifice of communication without entirely closing it; so that the blood, propelled from the left ventricle into the aorta, could, when this ventricle 'ceased to act, flow back, on account of the destruction of the sigmoid valve, into the right ventricle, by passing through this unnatural opening, the direction of which, however, appeared to be from the right towards the left ventricle.
"An important question, which, after the details of the case, and the examination of the body, seems still undecided, is, whether this opening existed from birth, or were accidentally formed by rupture or erosion. In the first case, it might be considered as-a vicious conformation; in the second, it should be placed in the class of organic diseases. The smooth and tendinous-like nature of its edges favor the former opinion, while the erosion of one of the semi-lunar valves extending even to the margin of the opening, and the existence of the tubercles, incline one to embrace the latter."
Having far exceeded our usual limits, we must refer to
the book itself for the fifth class, which treats of Aneurism of the Aorta, assuring our readers, however, that they will not be disappointed if they expect to find much useful information upon the subject. The volume terminates with some able corollaries from the diseases of which it treats.
On the whole, we have been highly gratified by the perusal of this work, which ought to be studied by all practitioners, for we think all might derive benefit from it. The translator appears (for we have not the original by us) to have executed his performance with care; and the language, though sufficiently grave for the English, is not devoid of the vivacity of the French idiom.
Some Account of Mart/ Thomas, of Tnnyralt, in Merionethshire, who has existed many years without taking Food; and of Ann Moore, commomy called the Fasting Woman of Tulbury. Accompanied with Portraits and illustrative Etchings. By James Ward, Esq. It. A. Imp. folio; : pp. U, and seven plates; Lond. 1813.
The case of Ann Moore of Tutbury, the woman who assumed the privilege of living without food, has been so much before the public, is so very generally known, and its fallacy has recently been so fully exposed, that we might be excused filling our pages with any further details on this subject, did not this elegant work, by Mr. Ward, demand from us an attention not due to the numerous herd of ephe-, meral pamphlets.
Mr. James Ward, an artist of great talent and deserved celebrity, having been called, in the course of his professional pursuits, into the neighbourhood of Ann Moore, made her several visits, and became convinced of the honesty and truth of her assertions. Impressed with this feeling, and looking upon her to be an extraordinary instance, perhaps, of a direct visitation from the Supreme Being, altering the accustomed course of the laws of Nature, for some inscrutable purpose, he investigated her history with minuteness, and examined her form and general external appearances with the eye of an artist. The result was the detail now before us, accompanied with two etched portraits, the value of which will probably deliver her History down to posterity, and record her imposition to future generations..
About the period of Mr. Ward's visits to Ann Move, accident brought him acquainted with Mary Thomas, a poor Welchwoman of Merionethshire, whose history, resembling in some points that of Ann Moore, was still more extraordinary, because her morbid state was much severer, and iiad