577

Winking and swallowing are, therefore,very different acts; the muscles of the eye-lids contract, producing the same result thatis effected by the tongue when it performsthe act of suction, either by drawing in8uids from without or from the surface ofthose parts of the mouth with which itcomes in contact. The eyelids and tongueare, therefore, lubricated by their own act,whereas the pharynx cannot do this foritself ; it cannot contract unless the secre-tive, or other fluids, be poured down uponit by the agency of other muscles than thosethat may strictly be called its own.

All those muscles which are immediatelyconnected with the digestive organs, muatbe highly influenced by the diminution or

irregular lubrication of the secretions.Hence, many of the anomalies of fevers mayoriginate. Kay, it may be a questionwhether one of the causes of paralysis henot owing to the sudden suspension ofglandular action in consequence of the lossof secretive matter, or of its being in a

vitiated state. I now allude to paralysisconsequent on impaired digestion. I haveknown several cases of partial and completepa’raly! is in dyspeptic persons after theinflammatory stage of influenza had passedoff. If the digestive organs had been in ahealthy condition, a reaction would havetaken place in consequence of a renewedlubrication of secretive matter.

If we pursue this suggestion closely, in-nnmerable facts present themselves in cor-roboration. In paralysis, even when nofever is present, the tongue and throat arealwavs dry, and in most paralytic personsthe thirst is excessive. Paralysis is a pros-tration, a relaxation of muscular power; it

may, in most instances, proceed from a se-quence of idtered structure of the nervousmasses, but it yet remains to be provedwhether that secretion which influencesnervous action,-the " succus nervoaua "

itself,-may not be suspended by the want ofintegrity in the secretory organs themselves.Only observe what a complete paralysis

of the pharynx takes place on attempting toswallow several times in quick succession,unless we lubricate it with the salivaryfluid or water. This, we now perceive,does not arise from fatigue, " the fatigue ofattempting to contract the tube severaltimes in quick sacceasion without giving itanything to contract on." We may give itever so many varieties of substance, greator small, to contract on, but they will pro-duce no deglutory action there, unless thesesubstances are well saturalted or lmbritatrdwith fluid...

Keither need this lubrication be in mass,so as to be of an appreciable quantity ordiameter, for tile gentle trickling down ofthe natural secretions of the mouth, or theallowing of small quaatitiea of water, dropby drop, to now down in coutinued succes-

sion, is quite sufficient to excite the pharynx,so as to produce the action of swallowing.The tube will contract fast enough, everysecond, for a length of time, and withoutthe least fatigue, if we continue to supplyit with a few drops of water at a swallow.There woutd be fatigue enough if we at.

tempted to throw down drv solids of thesize of a drop of water. In this case thepower of deglutition would be wanting, asthe surface of the pharynx, being dry, couldnot contract.

A.

ILLNESS AND DEATH

OF THE

LATE MR. MORI, THE VIOLINIST.

(Abridged from a Memoir by MR. E. W.DUFFIN, Surgeon.)

Anot:T nine yeara since I was first con.sulted profeuionally by Mr. Mori. At thattime he evinced decided symptoms of cere-bral disease, and on several occasions Icould regard his actions, and the sentimentshe expressed, in no other light than as theresult of mental aberration. But beforeattaining so advanced a stage as to give riseto the mental infirmities, peculiarities, andimpulses be manifested, the disease musthave been in progreas for a considerabletime. He was suspiciou., irritable, and im-patient of control. He was remarkablyenergetic in all his uadertakings, and jea-lous of rivalry to a most incredible extent.()u more than one occasion was my aid re-quested to appease hia frantic excitementafter witnessing the success of foreigu ta-lent, for amongst his own countrymen hehad no rival. He was extremely ambitiousto arrive at excellence in hi. profession, andto secure public applause and confidence.Indeed, such was his anxiety to afford satis-

faction, especially at his own concerts, thathis nervous excitement could only be re-

garded as a species of hallucination; andthe public will be surprised to learn that,calm and collected as he used to appear be-

fore them-so much so as even to be accused, of apathy-the ettort to maintain that tran-f quillity was painful to him in the extreme.I But he always assured us that when thet moment arrived, he could restrain his feel-t ings, and perfttrm his concerto M coolly ast if nothing had occurred.

It was under a paroxysm such as I havedescribed that he first experienced a singu-r lar cerebral attack, which for a few minutesdeprived him of sight ; on the restoration of

, which be fomnd his memory for lowic gone, sor that for nearly ax hour he cealrl neither readf the ntoes, nor play from memory. This occur-t red more than three years ago, and be had

sn6aeqnently several relapses of the samesort. On three occasions his left hand re-

576

mained slightly paralytic for several weeks, restless, and used to walk about from roomso that he could neither exert sufficient to room, practising and talking all the time.pressure to stop the high notes, nor move Unfortunately, a few months after Mrs.his fingers with sufficient rapidity to execute Mori’s death, another powerful passion tookdelicate passages. After one of these at. possession of his breast, for the occurrencetacks he found himself sensibly paralysed and uncontrollable nature of which, at suchin every part of his right side, more parti- an untimely period, he was, perhaps, nocnlarly in his hand and arm, so that it was more accountable than he was for the resist.with the utmost difficulty that he could com- less influence which appeared to govern allmand his bow. Another of his seizures his other sentiments and propensities. Heproduced loss pf memory and difficulty of became attached to a lady of high profes-articulation. As these consequences were sional attainments, and in this passion allnever of very long continuance, and it was others were absorbed, even his love of gaindesirable to conceal them as much as possi. for lie stated to me that he had offered, andble from the public, I could always succeed was still willing to make any pecuniaryin preventing his performance till he had sacrifice to obtain the object of his affections.nearly recovered ; but usually of late he His disease now began to gain more rapidlyplayed too early, and his defects in

couse- upon him. He ceased to practise, and be.

quence, both in execution and tone, did not came comparatively indifferent to his ownpass unnoticed by close and accurate ob- success or to that of others. The unhealthyservers of his performances. aspect of his countenance attracted univer.He was also excessively desirous of accu- sal attention. Is it not, then, surprising that,

mulating wealth; and as his disease pro- labouring under such jarring passions, mor-.gressed, in like proportion did he become bidly heightened by uncontrollable diseasemorbidly sensitive and avaricious ; yet he in the brain, he should have still retainedhas by no means died so rich as is currently the influence he had acquired among his pro-reported ; his family will be but indifferently fessional brethren. He now more frequentlyprovided for. Had his natural passions applied to me for advice. A variety of newtaken a different course, it is more than symptoms daily declared themselves. Heprobable that they would have led him to was affected with a very extensive ulcera-commit some outrageous act of insanity, tion of the throat, and his digestive orgauswhich might have consigned him to an asy- became greatly deranged. But he neverlum. Many an individual less deranged has complained of uneasiness either in the chestmet such a fate. But so long as they pur. or back, or exhibited any diagnostic indica.sued a natural channel they were never tion of the extraordinary aneurysm that ter-viewed in this light; and, had not a post- minated his existence. His pulse was al.mortem examination proved how little he ways feeble, but regular and healthy in otherwas accountable for their morbid manifesta- respects.tion, much unmerited obloquy might have About the 3rd of June (IS39), when heattached to his memory. This exposition was considerably amended in his generalwill go far to reconcile the resentment and health, but completely upset again by thesolace the injured feelings of those whom occurrence of his second concert of thishis uncourteous and irritable temper may season, I am informed that his strange con-have offended. Notwithstanding these mor- duct behind the scenes induced his brethrenbid passions Mori had still many redeeming to think that he was the victim of mentalqualities. He was warmty attached to his infirmity. Late in the evening of the 12thfamily, kindly disposed towards his friends, June he called at my house in the utmostgrateful for services rendered, and very for- agitation, and informed me that a few hoursgetful of injuries. before he had been seized with a suddenThe death of his wife, which happened pain in his back, which had gradually ex-

about eighteen months ago in the same tended itself along the whole length of theavrful and sudden manner, made a great’m- spine; that this pain was very much in-

pression on his mind. His grief, though creased on motion; that it prevented himshort, was very poignant, and wrought a from standing upright ; and that it was gia-great change in his dispositions and moral dually extending across the chest, so as tohabits. He became comparatively indiffer- produce a degree of constriction that mate-ent to everything which had before so much rially oppressed his respiration. His handsexcited and interested him. Prior to her were cold and tremulous, his pulse Ni-as

decease he was accustomed to practise in- feeble but regular, and his countenance iudi-cessantly ; the violin wss scarcely ever out cated the greatest anxiety. On applyingof his hand; and whilst conversing with my ear to his chest I fouud the heart beatingany one who called, either out of compli- slowly, softly, extensively, and in a mea-ment, or on business, he continued fingering sured manner; the breathing seemed muchsuch passages of difficulty as he was des:r- oppressed, bat I did not detect any otherous of overcoming. He slept little ; in fact, morbid phenomenon. Indeed, as will pre-watchfulness was one of the most prominent sently be shown, the diagnostic symptomssymptoms of his disease. He was extremely of the earlier stages of the disorder which

579

terminated his existence were masked by ’

the rapid advance it had made before becalled upon me. I requested a professionalfriend to accompany him home in a coach,and I followed in half an hour afterwards.Such remedies were then prescribed forhim as appeared to me most likely to affordimmediate relief; and we agreed that he should be again visited by some of the pro-fessional friends who had on former occa-sions met me in consultation on his case.On the following day, however, he was somuch better that he declined taking further.advice, and in the evening he got up andwalked about his room. At twelve’o’clockhe retired to rest; and, in about half anhour afterwards his family, who slept inthe adjoining chamber, hearing a strangenoise, went to him, and found him strugglingfor breath. In a few minutes he expired.

Post-mortem Examiastioa.

On the day following the body was exa-mined, in the presence of Dr. Child, Mr.Rogers, and several personal friends of thefamtlv.On removing the cranium, a considerable

quantity of bloody serum escaped from underthe dura mater. The slnunea and venoussystem in general were very much lI:ori/,edwith blood. The dura mater was somewhatthickened in its texture, and more densethan usual. It adhered very firmly to theglands of Pacchioni, which were consider-ably enlarged, and in a tubercular, semi-suppurating condition. The arachnoid mem.brane was thickened and opaque, the result of chronic inflammation of its texture. A

’

milk-coloured serum, and portions of coagu- lable lymph, were onused under this coatthroughout its whole surface, so abundantlyas to separate it from the pia mater to theextent ef the sixth of an inch. The piamater nncl substance of the brain weresoftened, and in some parts reduced to apultaceous consistence. The ventricleswere filled with serous effusion ; and a con-siderable quantity of fluid ran out from the

spinal canal. The arterial system was ossi-fied to a most remarkable extent, in everypart of its ramifications. The larger arte-ries, from being closely annulated with bonydeposit, were preserved quite patulous intheir calibre, and presented the appearanceof the trachea of a small bird, convey ing thesame impression when pinched betwixt thefngere as this tube would impart whensimilarly examined. The investing mem-branes of the arteries at the base of thebrain, and their larger branches, as well asof those of the internal carotids, ramified onthe corpus callosum, and on the anteriorand middle lobes of the brain, were

stretchecl so as to Itl1ow the vessels to noatabout, and to be easily raised to a distanceof several lines from the surface on whichthey rested. These elongations were so

considerable, that they might not inaptlybe compared to the mesenteric elongationsof the peritoneal covering of the intestines.TLe choroid plexus of vems was turgid,varicose, and bleached. These were allthe morbid appearances observed in thebead.

Chest.—The right cavity of the chest con-tained between six and scren pounds rfblood, which had separated into a bloodysernm and loose, grumous, dark-colouredcoagulum. This was found to proceedfrom a rupture of the pleura, opposite theattachment of the tenth rib to the spine,where it is reflected to form the thoracicpartition. On tracing this opening, whichwas large enough to admit my forefinger,we found the cavity of the posterior medi.astinum, in its wbole length, full of a darkcoagulum, which was easily separable fromits parietes. The effusion had distendedits walls, and forced a way to a considerableextent into the loose cellular membraneunder the pleural covering of the posteriorsurface of the lungs, so as to produce a veryextensive ecchymosis of this part. On fur-ther examination, this effusion of blood wasascertained to have proceeded from aaabeurysm of the aorta of a very remarkabledescription, the diseased and easily sephr.able coats of the blood-vessel admitting ofour tracing the formation of the tumour inthe most satistactory manner.

It appeared to have been originally form.ed by ulceration of the inner coat of theartery, opposite to the body of the eighthdorsal vertebra, and on the right side of thevessel. This opening was irregular in form.

but approaching to that of an oval, and

large enough to admit a moderate-sizedcrow-quill. A second ulceratioo, about

the size and shape of a small sptit bean,%which had succeeded in destroying the inner, coat of the vessel, was found close to theulcerated opening just described. Theblood, it appears, had first insinuated itself

at this point between the serous and muscu.lar coats of the aorta, and afterwards hadgradually separated these on the posteriorand right lateral surface in their whole rar-

tent ; the sac running upwards, and follow.ing the course of the arch, till the arteryemerged from the pericardium, and pro-ceeding downwards to within an inch of thebifurcation of the vessel. It presented theappearance of a secondary aorta, of irregu-lar calibre. At its lower fourth it did Dotmuch exceed the diameter of the blood-vessel ; its central half was nearly doublethe calibre of the vesul, and the upperfourth was of intermediate capacity. Thewidest portion was opposite the point offormation of the aneurysm, extending fromabout the fourth to the tenth dorsal verte.

bra. That it was formed by the mechanicalseparation of the coats of the artery, wasmoat satisfactorily ascertained, as the vessel

580

was in a very diseased state, and admitted Bof being torn with the fingers, so as to pro-long or enlarge the sac in any direction.The muscular layer was converted into awhite tough fibrous substance, that could beeasily torn in the direction of its fibres, andwhich, when peeled off from the cellular j Bcoat, presented the appearance of a piece of spinal medullary matter macerated in an alcoholic solution of bichlorate of mercury.The serous coat of the artery was studdedwith large ossific points and tubercles, someof which were as lar-e as a moderate-sizedbean. and in a state of semi-suppuration. Itwas one of these, I make no doubt, that hadsuppurated and produced the ulcer, whichgave rise to the aneurysm. That portion ofthe serous coat which was denuded of itsouter coverings, and formed the commonpartition between the aneurysmal sac andthe artery, was greatly thickened, and capa-ble of powerful resistance. The heart wasfully three times the ordinary size, and softin texture. The parietes of the left ventri-cle were hypertrophied. The coronaryarteries resembled those of the brain ; theywere closely anizulated with ossific deposit,so as to present the appearance alreadynoticed. Thev seemed to be detached fromtheir bed, and enveloped in a doubling ofserous membrane in the way we have alreadyexplained in describing those of the brain ;and in like manner was the connecting foldelongated, so as to isolate the vessels, andlet them float loose. The lungs, especiallythose of the right side, which were com-pressed by the effusion of so large a quan-tity of blood into the cavity of the pleura,*presented a very deep purple colour; andat their posterior surface, as already stated,they were ecchymosed to a very surprisingextent. The pulmonary arterial system wasin a healthy condition. The bodies of thevertebrae in the whole length of the spine,more particularly towards the right side,were absorberl in proportion to the durationand degree of pressure to which they hadbeen subject; the sixth, seventh, eighth,and ninth were most affected, and to a con-siderable extent, from which I concludethat the aneurysm must have been a lengthof time in progress. It is only singular thatMr. Mori never at any period complained ofsymptoms that led his medical attendants(and many from time to time prescribed forhim) to apply their ear to his chest. Hadthey done so, it is more than probable thestartling discovery that he laboured underaneurysm would hate been made.When he first consulted me. on the 12th

instant, the cavity of the posterior medias-tinum must have been full of blood, and itwas the rupture of the sac into this cavitythat occasioned the sudden and subsequent

* The chest contained between six andseven pounds of blood.

symptoms, resembling, in many respects, anacute rheumatic seizure of the dorsal, lum-bar, and intercostal muscles. When I ap-plied my ear to the region of the heart, Ifound the action of this organ to accord withhis pulse, 88, soft, and as it were stifled,but I heard no other sound : the fact is thebruit de souffiet, pulsating, and other charac-teristic phenomena, were then obscured bythe immense effusion of blood with whichthe aneurysmal sac was surrounded, and thepressure consequent on the confinement ofthis within the mediastinal pleura. Indeed,I much doubt whether in a case of thisnature the diagnostic phenomena would notat all periods of its progress have been veryobscure, complex, and difficult of analysis.No one would have ever imagined that ananeurysm would equal in extent the vesselthat produced it, especially such an artery

as the aorta. The ease and remission ofsymptoms he experienced on the followingday, and which induced him to believe thathis complaint was on the decline, wereowing to the distended parts having accorn.modated themselves to the novel circum.stances in which they were placed ; and theimmediate cause of death was the suddenrupture of the mediastinal pleura, so as toadmit of a further, and indeed tremendous,effusion of blood into the cavity of the chest,and completely compress the lungs, destroythe balance of the circulation, and thus ex-tinguish life. No other morbid appearanceswere discovered.These facts are replete with novelty and

interest to the physiologist and pathologist.That a man who laboured under such exten-sive disease in the brain should have beencapable of displaying so much well-directedenergy as Mori always evinced in every.thing he undertook, is very remarkable.Being on several occasions seized with pa-ralysis, loss of sight and memory, in conse-

quence of organic disease of the brain, he againrecovered the use of the parts and sensesaffected, is no less remarkahle. And whenwe reflect on the extensive and singularcharacter of the aneurysmal sac, and theslender boundary that it placed betwixt lifeand death for many months, we cannot butshudder at the risk of death he daily ran, inthe midst of his most successful undertak-ings.

14, Langham-place,June 29, 1839.

LOCAL USE OF IODINE.

.

WE extract the following from a well-written brochure, lately published by Mr.John Davies, of Hertford, and entitled,

" Practical Remarks on the Use of Iodine,Locally Applied, in various Surgical Dis-eases and External Injuries :"-