135

longitudinal rupture, leading into the leftventricle, six lines in length, and half a linein breadth ; its edges were irregular andlacerated. About three lines distant fromthe former, another longitudinal rupture wasfound, which was, however, still covered bythe pericardiallining of the heart. The leftventricle was considerably enlarged ; its ex-ternal and internal linings were healthybut its muscular tissue, especially round thefissures, without any appearance of fibres,and had degenerated into a soft, yellowishwhite pulp. The right ventricle, as well asthe large vesselsj was perfectly healthy.A similar case is related of a youu; lady

who died suddenly, when apparently in theenjoyment of good health. On examiningthe thoracic viscera, the pericardium wasfound filled with blood, the source of whichwas a rupture of a small aneurismatic tu-mour at the origin of the aorta. The pari-etes of the tumour consisted only of the in-ternal and external lining of the heart; themuscular tissue around it was softened.-Ibid.

ON THE PROPHYLACTIC POWERS OF BELLA-

DONNA AGAINST SCARLET FEVER.

By C. W. HUFELAND.

THE author has been led, both by his ownexperience and that of a great many otherpractitioners, to form such a favourable opi-nion with respect to the powers of thismedicine, that he is convinced that in epi-demics of scarlet fever it ought universallyto be resorted to, as the best means of pre-venting the disease altogether, or mitigat-ing its violence. The following are his

general conclusions :—1. The proper use of belladonna has, in

most cases, prevented infection, even inthose instances where, by the continual in-tercourse with patients labouring underscarlet fever, the predisposition towards itwas greatly increased.

2. Numerous observations have shown,that by the general use of belladonna, epi-demies of scarlet fever have actually beenarrested.

3. In those few instances where the useof belladonna was insufficient to preventinfection, the disease has invariably beenslight.

4. There are exceptions to the abovethree points, but their number is extremelysmall.

It seems that in some epidemies bella-donna has no protective powers at all ; theindividual disposition, the method of usingthe remedy, and the quality of it will, ofcourse, have considerable influence on theresult of the experiment. Three grains ofthe extract, which must be recently prf-pared, are di3s,,)Ived in three ounces of’ di-

luted alcohol ; of this solution the indivi-dual takes, twice a-day, as many drops ashe is years old ; its use must be continuedas long as contagion is possible. The dose,it appears, is so very small, that eten if itshould fail in its effect, it will, at all events,not be injurious.

In consequence of Hufeland’s communi.cation on the above subject, the Prussian

government has issued an official decree,ordering the general use of belladonna, as aprophylactic in all instances when scarletfever prevails as an epidemic.—Liter. Ann.der ges. Heilk.

THE FOURTH CASE OF CHOREA.

Communicated by a Medical Fniend to Dr.HARRISON, and by him to THE LANCET.

A. B., a delicate girl, only eight years old,and four feet nine inches in height, has men.struated regularly during the four precedingmonths. The mammæ are already imper-fectly evolved. Some menstrual efforts hadtaken place, at the age of six years. Thesewere unattended with any perceptible de-rangement.

" To me," the Writer observed," it appeared a fair opportunity of ascertain-ing whether this might not decide (as far asa single case could decide) the late disputeson the Continent, respecting’ the use of thecerebellum. In the present instance, alongwith the premature development of the mostimportant sexual function, there existed atotal loss of control over the voluntarymuscles. The cerebellum then may be es.

sentially connected with the sexual fnnc-tions, as has been supposed- by Gall andSpurzheim, and yet be the organ principallycontrolling the voluntary muscles.

°° On examining, that part of the occiputcovering the cerebellum, it was found ratherlarge, and the heat very perceptibly greaterthan at any other part of the head. It was

resolved, therefore, (all the usual meanshaving been previously employed withoutany benefit,) to try the effect of repeatedlocal bleeding, together with the continuedapplication of cold, attention being paid tothe state of the bowels. Under this modeof treatment, the patient recovered in thespace of a month, not the slightest spasmremaining. The cessation of the spasmswas attended with a cessation of the men-strual discharge. She remained perfectlywell during eight months. At the end ofthis time, menstruation again took place,and, along with it, a return of the spasrnodicaffection. * Similar means were resorted to,and similar effects have followed."

Remarks by Dr. HARRISON.In this case, although the patient had

136

only attained her eighth year, the constitu.tion was already considerably evolved. Themammae were in some degree enlarged, and,for the preceding four months, she had re-gularly menstruated. Eight months after-wards the catamenia and spasms returned,and disappeared together. Efforts to men-struate had also been observed, when shewas only six years of age.

’

The uterine system, the most influentialof the female organs, is liable to many ac-cidents and derangements, which have atendency to disturb and injure its functions,and extend a morbid action over the wholeframe. In early life, this viscus and its ap-pendages are small and quiescent. As the

body grows, they not only enlarge alongwith it, but undergo extraordinary modifica-tions to fit them for the business of procre-ation, and to nourish the tender foetus. Thefull development of the sexual organs occu-pies several of the earlier years. Towardsthe decline of life, they are destined to un-dergo ulterior changes, which incapacitatethem from continuing to discharge theirproper offices. These two periods consti-tute the most important eras in female life,and lay the foundation of many distressingailments. The maturation of the generativemembers takes place at different ages indifferent countries, and with different indi-viduals. In England, the bodily organisa-tion is seldom fully expanded before thefourteenth year, or later. Its completion ischaracterised by many constitutional evolu-tions. The most remarkable are displayedin the uterus and ovaria. In the former, pe-riodical discharges occur of a peculiar na-ture ; in the latter, a vivifying fluid is gene-rated, which, being mixed with the malesemen, forms the rudiments of the human

embryo. When the mammæ enlarge, andthe uterine organs display their functionsprematurely, the health generally suffers inconsequence of the unnatural changes.We are wholly ignorant of the methods

employed by Nature to effect these constitu-tional alterations. They are, however, ob-viously attended with a partial determina-tion of blood, and dilatatioIl of the imlili-cated vessels. But by what secret contri-vances and previous arrangements theircalibre is increased for these important pur-poses, we know not. It is, however, cer-tain, that whenever the natural evolutionsof any part take place unseasonably, irre-

gular efforts ensue, and uisorciers are set upin the same organs. Of this remark, wefind the most striking and unexceptionableillustrations, in contemplating the morbidphenomena, which follow sudden changes,in departments of the human frame, lyingunder our immediate cognisauce. We find,moreover, that so long as the various parts ofthe body expand simultaneously, they main-

tain a just relation to one another, and aharmonious co-operation is preserved. Xomorbid determinations ensue. No dispro.portioned growth is observed ; no disorderof irregular formation occur. The consti.tution increases progressively, and the cor.poreal evolutions appear in regular succes.sion. When the body enlarges in some

parts faster than in others, the natural con.cordance is interrupted, and confusion pre.vails in the system. This derangement laysthe foundation of numerous maladies. A

precocity in the sexual organs is the fertilesource of nervous complaints. The consti.tution, subjected to the powerful agency ofa new stimulus, before the stamina are pre.pared to receive its impulse, suffers fromthe inordinate operation superinduced. Inthe present instance the uterine, and pro.bably the ovarial functions also, were

brought into play, before the due season.The irritation thus produced, acting uponthe nervous fibrils of the sexual members,and being conveyed from them to the spinalchord, or organ of motion, occasioned thechoroid agitations displayed in this case.Many examples of mania, as well as of

epilepsy, hysteria, and other convulsivemaladies, originating in the sexual viscera,are upon record. Although the excitingcause operates first upon these organs, itsinfluence is extended from them to thenerves of voluntary motion ; and is, more.over, occasionally transmitted along the

spinal chord to the brain. Here, by dis.turbing the sensorium commune, the mindis made to participate in the affection. Thisshows itself in different degrees of tempo.:ary, or more permanent, derangement. Itis of great importance, in practice, to dis-

tinguish this variety from the other species,with which it is too generally confounded,I have had occasion to witness the errone.ous notions, in this respect, of medical men,and their employment of remedies to thehead, when the epileptic paroxysm, forexample, originated in the teeth, the diges.tive organs, or other remote part. In a re-cent case of this sort, which had been

treated with leeches, blisters, and cold affu-sion upon the head, I discovered that themother was in a state of pregnancy. Nosooner had another wet-nurse been substi.tuted for the natural one, than the complaintdisappeared, affording a convincing proof

! that the epileptic symptoms originated inuuwliolosome food.The ingenious writer of the present case

seems inclined to attribute the chorea, andearly menstruations, to a morbid conditionof the cerebellum, because he found the ca-pillitium over it hotter, externally, than thesurrounding scalp. This source of convul-sions has lately been advocated by learnedand able patliologiats. It is a question

137

which experience can alone determine. Inthe mean time we may observe, that al-

though the occiput was preternaturallyheated, it does not follow that the cere-

bellum was the seat of chorea. I am notaware that increased action of the encepha-lon, or its membranes, necessarily leads toany augmented warmth in the part exercised.According to my views of chorea, the dis.order, in this instance, is to be looked forin the generative system, rather than else-where. These important organs were pre-maturely evolved, and called into inordinateaction, before the constitutional energieswere sufficiently matured and invigoratedto bear the new stimulus with impunity.Hence they gave way to causes which,under more favourable circumstances, wouldnot have produced any morbid impressionor disturbance. Besides, as means were

employed at the same time to regulate thebowels, I am inclined to impute her cure tothem, rather than to the local application ofleeches, and cold applications to the occiput.Moreover, as the chorea and uterine evacu-ations disappeared simultaneously, I thinkthe choroid manifestations only left her, onthe irregular movements of the uterus ceas-ing to agitate the frame.

Of Puerperal Convulsions.

Having, for the present, concluded thefew iemarksthat 1 proposed to make on theabove case, I now proceed to the considera-tion of another distressing malady of theuterine system, still involved in great ob-scurity. Many of its leading symptoms bearsuch a striking resemblance to the precedingcase, as to justify their being placed to-

gether, and to encourage a reasonable ex-pectation, that by regarding them in thisway, they will mutually illustrate eachother. The latter disorder, generally calledpuerperal convulsions, having bereaved

many husbands of dear and affectionatewives, claims our anxious solicitude. More-over, by depriving the British people of anamiable princess, it lately plunged a wholenation into the deepest misery and affliction.Though always an attendant on parturition,it sometimes precedes, sometimes follows,that interesting event. The attack is al-

ways sudden, and generally unexpected.The symptoms are peculiarly violent, imi-tating hysteria or epitepsv, but they are

much more extravagant and distressing thaneither. Sometimes it appears under thesemblance of general convulsions. Thecountenance is more hideously distorted,titan it is possible to conceive ; the eyesopen and shut in quick succession ; themouth is in continual motion, and emits anindescribable hissing sound ; the lips are

covered with foam ; the breathing is often

stertorous, and the limbs are tossed aboutwith the most frightful agitations. To addto the miserable situation of the mother, sheis all this time in a state of total insensi-bility. According to my experience, thecomplaint is produced by sharp and hastylabours, rather than lingering or unnaturalbirths. The weakly and indolent are moreliable to suffer from it, than the hardy andactive.The origin of this alarming disorder has,

among other causes, been imputed to anirritable condition of the womb. To me, it

appears rather to proceed from an injury in-flicted upon the uterine nerves, than from

any other cause. By the too rapid andforcible dilatation of the cervix uteri, os

tincae, or vagina, some of the nervous

fibrils are so suddenly elongated, as to be-come fretted, unduly stretched, or perhapsactually torn, if not burst asunder, in strug-gling to expel the child. The morbid affec-tion impresséd upon these minute nervousramifications is immediately conveyed tothe great sympathetic and spinal chord. Itis then carried to other spinal nerves, bywhich means those distressing spasms areproduced in the muscular system, as al-ready explained.

Several years ago I was sitting beside amiddle-aged female, the mother of severalchildren ; she was of large size, and verycorpulent. While reclining in an easy chair,and engaged in conversation, she suddenlysprang forward, and fell prostrate upon thefloor, as if dead. She was far advanced in

pregnancy, but had given no previous noticeof the approaching accouchement. After ananxious pause, and suspension of the vitalpowers for a few seconds, general convul-sions burst forth in the most sudden manner,and to an alarming degree; they seized uponthe limbs and countenance at the samemoment ; both were frightfully agitated,and she writhed incessantly. The childwas speedily expelled by the mother’s ownefforts, and without her being at all con-scious of what had taken place. The pla-centa immediately followed, unattended

by any particular circumstance. No pulse, could be felt for some time, and the vibra-tions of her heart were scarcely perceived.The spasms continuing unabated, a largedose of tinctuie of opium was iven. Theroom being daikened, and perfect quietudeentorced, she gradually stitik into a dis-

turbed, and afterwards a calmer, sleep. Inthis state she remained four or five hours,and then awoke completely exhausted. Theaction of the heart and arteries being stillvery feeble, I persevered in the means

above recommended ; these, with saline re-medies und aperi&nts, prevented the recur-rence of fits, and she slowly recovered herformer health.

138

Soon afterwards I was called to a robustand healthy female, about twenty-five yearsof age ; it was her first child. The labourhad been sharp, but of short duration. Sheremained free from pain only a few minutesafter the accouchement; she then became

suddenly and universally convulsed, withthe most horrifying spasms ; her face, eyes,and mouth were frightfully distorted, and incontinual motion. I found her insensible,and unconscious of every thing around her ;the countenance was flushed, and the pulsebeat about 85 strokes in the minute ; it wasrather strong, full, and hard. A vein beingfreely opened, twenty ounces of blood werespeedily extracted ; the arm was then bound

up. The fits became milder from that time,and returned at longer intervals. A fulldose of opium procured several hours’ sleep.On her awaking, it was discovered that the

bandage, having slipped aside, more thantwenty ounces of blood had escaped fromthe orifice into her bed. This second loss Iof blood was so effectual that the fits neverreturned ; the face appeared no longerflushed, and her skin felt cool; the pulsehad become small, soft, and of moderate fre.quency. By strict attention to regimen,and the state of her bowels, together withanodyne and saline medicines, she soon re-gained her former health, and was able tosuckle the child. She lived tube the motherof five or six children, but had no returns iof her spasms.

So many distressing ailments, arising fromlocal injuries to particular nerves, are re-

corded in medical books, that I think weare warranted, from analogy, to impute theinvasion of puerperal convulsions to thelesion of some nerve in the uterus or vagina.Before I proceed to the cure I will detainthe reader, by relating’ three instances ofinjuries to the nerves in other parts of the

body ; they came under my own observa-tion, and although similar examples haveoften occurred to others, they are, 1 think,calculated to strengthen, if not actually toestablish, the doctrines 1 have advanced.

Being sent for to a distant patient, i wasdesired to see the wife of a medical prac.titioner in the same town, who was afflictedwith distressing spasms , they returned, atuncertain times, every day, affecting bothher legs, arms, and visage for several ini-nutes. She retained her senses during thefits, and soon recovered after they were over.I was informed, that she had met with anaccident, several months before I saw her. IWhile engaged in cutting some slices ofbread the kmfe slipped, and passed into theinside of her thumb. Though no more painthan commonly occurs after such a woundwas felt at the moment, spasmodic twitcl-ings commencing in the same thumb weresoon perceived ; they quickly extended from

it over the whole member, to the other arm.

to both legs, and the countenance, produc.ing hideous distortions of the face and

!violent convulsions in the limbs. Under astrong persuasion that a branch of the me.dian nerve was partially cut, or some of itstwigs unduly stretched, or fritted by the

injury, I recommended, with a view to re-lieve the part; that a deeper incision shouldbe made in the same place. The opinionnot being supported by the attending phy.sician, or agreeable to the patient, it was

! overrules ; though many remedies were afterwards tried the spasms continued un.

abated. Disappointed in her expectations,she was at length induced to visit Ediu.burgh, and place herself under the care ofthe late Professor Monro ; by his directionthe thumb was amputated a little below the,hurt. The convulsions immediatelv disap.peared, and never returned. It is, I think,a reasonable inference, that the spasms pro.ceeded either from injury of a branch of thernedran nerve, or some of its fibrils. Al.

though the mode pursued was certainly themost effectual, I am sorry that a regard forthe usefulness of the thumb did not leadthis eminent practitioner to try the effect ofa deep incision before he proceeded to dis-memberment.CASE 2. A similar accident befell anelderly lady, from the same cause and in the

same part. Convulsions immediately super.vened, for the first time in her life; ahealways felt them in the wounded thumb,and they were propagated more or less ex-tensively from it to the limbs and face. Thecut soon healed, and after a few months thespasms gradually left her.

CASE 3. I was called, a few months since,to a healthy boy, of the sanguine tempera-ment, and about eight years old. He was

brought from the country to London for me-dical advice, afflicted with violent spasms i-ahis face and limbs : they returned everyhour or two, and each fit lasted more thanfive minutes ; his intellects were not in theleast affected, nor did he suffer internally,except from involuntary discharges of urineduring the paroxysms. On examination, Idiscovered a hard inflamed lump in his neck ;it felt hot to the touch, and appeared abouthalf the size of a sriiall St. Michael’s orange.This swelling was situated on the left side,over or near to the great sympathetic, parvagum, and origin of the phrenic nerve, as

well as several of the cervical nerves. Idid not hesitate to refer the convulsions tothe pressure of this hard and inflamed 1Iodyupon the cluster of nerves under it. Thisopinion being confirmed, by one of the mosteminent anatomists and surgeons in themetropolis, our indications were formed ac.cordingly. The boy was first put into awarm bath, and the phlegmonous tumour

139

was afterwards fomented half an hour with ’,the decoction of poppy heads and chamo-mile flowers. A linseed poultice was thenplaced over the same part. The fomenta-tions and poultices were renewed every sixhours, till suppuration came on ; this tookplace the third day, and - the pus was care -fully discharged. The abscess healed in afew days, but so successful was the treat-

ment, that no convulsions appeared after thefirst bathing and fomentation.But to return to the consideration of our

proper subject. It cannot, I think, be de-nied, that a bruise, or other injury of theuterine nerves, received from the pressureof the child in parturition, is in itself not

only quite sufficient, but often produces thewhole train of symptoms which constitute

.puerperal convulsions.According to the etiology of this formid-

able disease, as above laid down, it will benecessary to add to the remedies usuallyconfided in, such as have a direct tendencyto sooth and compose the uterine organs ;for this purpose opiates are particularly re-quired ; they may be given by the mouth,and passed into the vagina, or rectum. Im-mersion in the warm bath, or hip-bath, willalso be highly serviceable, and may be fre-quently repeated. Neither should anodynefomentations to the abdomen and pud-endabe overlooked or neglected.

(To be continued.)

VITALITY OF THE BLOOD.

" llirahile vidPtnr quod non rideat haruspexcumbarospicem videiit: huc nytrabilius quod vos intervos risum tenere possitis."

Cicero de Nat. Deor. Jib. i.

CURIOSITY has been so much excitedin anticipation of the peculiar views of Dr.Whiting, on the subject of the vitality ofthe blood, that 1 for one looked forward withsome degree of anxiety for that importantperiod, when the debates of a certain So-

ciety upon " reports" and " explanations"

might suffer a biief interruption, and permitthe learned Doctor to overturn the Hun-terian doctrines by the splendour of his elo-quence, or the force and vigour of his argu-ment. Such a consummation has, at length,happily occurred. The "awful din of pre-paration" has been succeeded by an eveningredolent of weighty truths; and the obste-tric talents of Mr. Bransby Cooper havekindly assisted the parturient efforts of themountain pregnant with a mouse.

But, beggmg pardon for the levity of anexordium III adapted to the subject, per-mit me to ask buth Mr. Cooper and the

Doctor, whether they are sensible of theerror they have equally committed, in sup-posing the coagulation of the blood, whenexterior to the body, to result from the ac-tive agency of vitality, or any other powerpeculiar to that fluid ; or if they do not con-ceive it more reasonable to suppose, that bethe blood alive or dead while in the body,coagulation out of it occurs in consequenceof its removal from the operation of causesby which it was previously influenced ; infine, that the separation of its constituentparts takes place, not from the positiveagency, but from the actual negatiart ofthose powers by which it was before pre-served in a state of fluidity,, So far, then,conceive the speakers to have been equallyin error with regard to the uses they havemade of the fact of coagulation, as an argu-ment for or against the question at issue ;while, if viewed in its proper bearings, Iconceive it to be essentially subversive ofthe doctrines which Dr. Whiting advocates.When blood is removed from the body,

we know, as a matter of fact, that it speedilyseparates into two portions-one more orless solid, the other fluid ; and we know itfrom experiment to be equally a fact, thatheat and motion, the oniy known agenciesindependent of life, to which it is subjectedwhile in the body, may be applied in equaliutensity to blood exterior to the vessels,without their retarding, or accelerating, orpreventing in any appreciable degree thechanges which, under such circumstances,it undergoes. The fair and legitimate, nay,the inevitable conclusion from these facts

appears to be, that coagulation takes placein obedience to the chemical laws of solu-bility,. upon the removal of some power, oragency, which had previously suspended ormodified their action ; and, as we have po-sitive evidence that the condition of theblood, with regard to its fluidity or other-wise, is not influenced either by the che-mical agency of hear, or the mechanical

agency of motion or attraction, so are we

compelled to attribute the phenomena it ex-hibits in the one case to the presence, andin the other to the loss, of that power, oragency, or principle, or by whatever othername we may call it, which not only in theblood, but throughout every fibre of the

living body, controls and modifies, and sus-pends the ordinary laws by which the

changes in dead matter are regulated ; inother words, I conceive we are led to theconclusion that the blood is fluid, simply be-cause it is alive; that it coagulates, simplybecause it is dead.The Doctor triumphantly exclaims, " If

the blood were vital, it ought to show itsVitality during life, and not wait till after! death to do so." Now the fact I maintain

to be, that it does show its vitality during