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dreadful consequences would ensue; which is well exemplified in cases of disease of the right ventricle.
If we examine the heart of a large animal, we will see the accuracy
of the above statement. It even extends so far as to give an apparent pulsation to the jugular veins, which has led some authors to adduce this symptom as pathognomonic of disease in the right cavity of the heart.
A third circumstance frequently occurs, which would defeat the object of Nature, if she had any design in preventing the mixture of the two currents of blood. This is the variety in the insertion of the ductus arteriosus into the aorta, which occasionally takes place before the carotid or axillary arteries are sent off, and at other times just opposite to them. The intermixture of blood must therefore happen, in opposition to all the care taken to prevent it, in the right auricle. These facts throw some doubt on the explanation of Sabatier, which has been so generally received. What the real function of the Eustachian valve is, seems at present to be unknown. Whether it be serviceable in removing the pressure of blood from the inferior cava, or when ther it has any function at all, we leave for others to conjecture, and time to set them right.
Case of the Effects of Tobacco. Communicated by MARSHALL
HALL, M. D. &c.
ON n May 24th, 1815, Mr J. H., aged 19, unaccustomed, ex
cept for a day or two before, to the effects of tobacco, smoked one, and part of a second pipe, without employing the usual precaution of spitting out the saliva ; and partook, at the same time, of a little porter. He became affected by violent syncope, and by violent retching and vomiting. He returned bome, complained of pain in the head, undressed himself, and went to bed. Soon afterwards, he was taken with stupor and laborious breathing.
He was found in this state by the medical attendant. The countenance was suffused with a deep livid colour ; the eyes
lost their brilliancy; the conjunctivæ were injected; the right pupil was exceedingly contracted; the left was much larger than usual, and had lost its circular form: Both were unaffected on the approach of light.
The hands were joined, and in a state of rigid contraction"; the arms bound over the chest; and the whole body was affected with spasmodic contraction.
The breathing was very stertorous; pulse about 80 or 82, and nearly natural in other respects. No more vomiting ; no stool or urine passed; no palsy.
Fourteen ounces of blood were immediately taken from the temporal artery, and vinegar was administered. He revived evidently; the countenance became less livid; the spasmodic affection of the hands ceased; the respiration became less stertorous; the pulse was not materially attected. An ipecacuanha emetic was given, and operated once, and afterwards some purgative medicine was administered.
He dosed through the night.
On the morning of the 25th, the patient was affected with syncope, during the efforts made to get out of bed and go to stool. At the visit, he complained very much of pain of the head and eyes; the eyes and eyelids appeared red, and suffused. Pulse 80, and natural. Tongue loaded and brownish; one stool, Continued to dose. The feet were cold in the morning. Sixteen ounces of blood were taken from the arm.
On the third day he still dosed ; complained of pain of the head, of nausea, and of tendency to fainting. Countenance more natural; the pupils natural, and contract by light. Pulse 72. A loose stool passed insensibly in bed.
In the evening of this day, the patient again became affected with a degree of stupor, spasms of the hands, and sterior in breathing. The countenance was not livid ; Zvj. of blood were drawn from the temporal artery: vinegar was given ; a blister was applied to the forehead, and mustard cataplasms to the feet, with much relief to the symptoms.
On the 27th, or fourth day, the patient appeared much as on the preceding morning. There was some pain of the head. No sickness or vomiting; one scanty loose stool. Dosing continued. Tongue dry and parched.
May 31.-Since the last report, he has gradually recovered ; the headach, pain of the eyes, and drowsiness ceasing; a little obstinacy of the bowels; some appetite ; tongue, &c. becoming natural.
The patient is at present (August) perfectly recovered.
This case seemed, on its first aspect, to wear the form of apoplexy, its cause being unknown. The appearance of the countenance, the state of insensibility, the stertor in breathing, are the same in both affections: But the absence of paralysis ; the spasmodic affection being generally observed on both sides of
the body; the natural state of the pulse ; the manner of the ate tack; the succession of the symptoms of syncope, nausea, and vomiting, and affection of the head, all concurred in distinguishing this affection from any kind of apoplexy.
Indeed, the symptoms of the case were sufficiently peculiar: Syncope, succeeded by nausea and vomiting, and subsequently by violent pain and affection of the head; coma, and stertorous breathing, without paralysis, and with little affection of the pulse; the tendency to dosing, and to syncope on a change of posture, or on any exertion ; the languor of the circulation observed in the extremities; all these circumstances, taken together, seem to characterize decidedly the effects of tobacco, and to distinguish them from any other affection. It may be useful, however, on similar occasions, to recall to mind, that apoplexy, an injury of the head, a fit of epilepsy, a state of deep intoxication, the effects of other narcotics, asphyxia, syncope, &c. are all af. fections which, with the one recorded in this case, require to be accurately distinguished from each other.
The treatment employed by the surgeon in this case seems to have been very efficacious. Perhaps the opening of the jugular vein would have been equally so, as the lividity seemed to indicate a redundancy of venous blood. But in spasmodic affections, the temporal artery is more accessible, and more promptly, and more conveniently opened. The particular treatment here mentioned was followed in the later periods of the complaint, by such remedies as the symptoms seemed to require, and especially by repeated doses of calomel.
Nottingham, 20th August 1815.
Observations on the Plague at Malta. By William STAFFORD,
Surgeon, Ist, late the 8d, Garrison Battalion.
very lately come to my hands, and, at the same time, De Chisholm's Remarks on Contagious Fever, where my practice is alluded to, I feel myself, in some degree, called on to state, by a few cases, what that practice was, my reasons for adopting it, and the effect I expected to be produced. To enable me to do this, it will be necessary to recur to the first appearance of the disease, and the situation of the battalion under my care.
Early in May 1813, the chief medical officers of regiments were ordered by the Inspector of Hospitals to attend him, when he informed us, that he had that morning inspected the dead body of a woman who had died of plague; that the whole city and country were in a state of the greatest alarm. How far the infection had spread could not be known. He recommended to us to be strictly on our guard; to make frequent inspections, as it was very probable, from the incautious life of a soldier, some one might receive the infection, and communicate it to the rest of the garrison. He immediately ordered us to assemble as a Medical Board, and appointed Sir B. Faulkner to preside. When we met, to our mutual astonishment and distress, we discovered that none of us had ever seen the plague. All of us had read many authors on the subject, and all that we could learn was, that the disease was generally fatal, under every mode of treatment heretofore practised. A part of our instructions was, to draw up a few medical rules for the guidance of the Maltese. From the state of our knowledge of the disease, we could have but little to recommend, and this was chiefly to keep the bowels open by mild laxatives ; to drink plenty of lemonade ; and, in case of any attack of fever, to take a little spt. minder, frequently ; a medicine they knew, and always took in cases of slight fever. The rest of our recommendations related to strict attention to cleanliness, frugality in diet, and temperance in conjugal pleasures. Though this last caution may cause a smile at present, it will, on reflection, and after reading what follows, perhaps be treated with respect.
My battalion was quartered at Floriana, a fortified outwork to the city of Valletta. The works are somewhat in the form of a half-moon, and are between two and three miles round. I imagine, at the commencement of the disea c, it contained about 6000 souls, of which about 1600 died. Whole streets were depopulated, and very few houses escaped. Under my quarters, three separate families lived, and had no communication with each other, and some died out of each. Floriana is the only outlet from Valletta to the country. All the people that died in the city, all the sick sent into quarantine or observation, infected clothes, &c.--the dead carts sometimes so full, that the covers could not be shut down, and, from the pressure of the bodies on each other, the carts might be traced by the quantity of pest-matter running from them :-all the pest-hospitais for the Maltese, places of quarantine and observation, were in the ditches of Floriana, under the eyes of our sentries, who fre
quently, at day-break, saw heaps lying on each other dead; and, during the whole of the day, numbers under the severe and last agonies of the disease.
I have been thus particular in describing the situation of Floriana, where ours was the only regiment to do every part of the military duty, by guarding all these extensive works." The officers and men had of course to traverse the town in every direction. I likewise wish to show how next to impossible it was that we could escape, as some severe observations have been made for our suffering it to appear among us.
All the regiments quartered in Valletta were lodged in palaces. The door being locked, they might be supposed to be secure; yet some of them suffered, and one of them received the infection first. This being the case, it was necessary for me to form some plan to meet it. We, however, escaped from early in May to the 14th of June, during which time I had frequent opportunities of inquiry. I found the practice of the Maltese medical gentlemen was by no means fortunate. I was informed that the first 60 patients were bled, and that 59 died, from which it was evident I had nothing to expect from the lancet. I am sorry I have so few cases to record, which I attended myself through all the stages. On the disease first appearing in De Rolles, quartered in Valletta, a pest-hospital was formed in Floriana for the military; and when a case of mine was identified as being plague, the patient was sent to this hospital, from which I am sorry to observe very few returned.
The symptoms of this disease have been so ably and fully described by Sir B. Faulkner, that it is unnecessary for me to repeat them. They cannot be stated by any one with more precision or elegance. I am sorry I could not often communicate. with him at the time. We were in complete quarantine with regard to each other.
Case I. 14th June 1813.-JERRY WISEMAN, aged 32, spare habit of body, complains of headach, pain across the lumbar region; has had slight rigours ; eyes clear but dull, as though under tbe indirect influence of liquor; tongue a pale chalky white, with a brown streak in the centre; a tumour in the inferior gland of the groin, about the size of a walnut, with but little pain ; bowels regular.
R. Calom. pptt. gr. X.
Jalap. gr. xv.
Cons. q. s. ft. bol. to be taken directly. And to rub in zij ungt. hydr. along the course of the absorbents.