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rhages are dis inguished by authors as active, passive, constitutional, accidental, succedaneous, crítical, internal, and external. They are also either interstitial or on the free surfaces.
There is not always any manifest erosion by which the blood has escaped from its vessels, and in such cases it seems necessary to admit an alteration both in the fluids and solids, but it is impossible to state the intimate cause of such a phenomenon. When death has been caused by profuse hæmorrhages, the sanguiferous system is found almost empty-the blood which it contains is pale and serous—all the organs are reduced in colour, and the heart is contracted on itself. M. Beau has lately advanced an oppo. site assertion (see Archives de Medicine, 1845), viz. that, in those who die after having suffered from repeated hæmorrhages, the heart is hypertrophied and dilated. The fact is far from being established on positive proofs, and at present it has scarcely any support except from a few experiments performed on inferior animals.
We may pass over most of the forms of hæmorrhage, which are arranged very much in the order adopted for the corresponding inflammations. A single page is allotted to hæmatidrosis or bloody sweat, of which it is observed, "there exist a certain number of well-authenticated observations to prove that blood has sometimes been exhaled from the skin, probably by the same course as the perspiration. Such hæmorrhages are rarely general—they are partial, and are seen on those parts on which the skin is white, fine, and often bathed with sweat"_" or they may take place on the surface of an old cicatrix.”
The cases alluded to are such as having occurred in young and middle-aged women, were connected with amenorrhæa or deficient menstruation ; but no mention is made of another form of hæmatidrosis, which has in some rare cases occurred in conjunction with great disturbance of the circulation, arising from moral or morbid causes affecting the heart. A careful commentary on such instances is to be found in the recent and 'remarkable work of a learned and accurate English physician, Dr. Stroud, who, in treating on the Physical Cause of the Death of Christ, has had his attention directed to this symptom related by Luke, as accompanying the agony of our Lord in the Garden of Gethsemine.
Of the interstitial hæmorrhages to which the name of apoplexies has been given, cerebral apoplexy is the most important. After noticing the well-known fact that, the paralysis consequent on cerebral apoplexy occurs on the side of the body opposite to that on which the effusion of blood on the brain has taken place, the author says. “ There exist, however, some authentic observations of paralysis taking place on the same side as the effusion, but these cases are too decidedly exceptional to prevent our stating, in a case of hemiplegia, that the seat of the effusion is in the opposite hemisphere. Is it possible to localize the malady more precisely? Can we for example, assert that the effusion is in the middle or the anterior lobe, in the corpus striatum or the thalamus opticus, or in the cornu ammonis, or in the convolutions from indications afforded by the seat and limits of the paralysis. I regard this localization as impossible in the present state of Science.” Though he founds his opinion on the numerous observations of Andral and Finck, who arrived at this conclusion, we must admit that we still attach great confidence and importance to the views of Dr. Foville, 18471
35 who, though not named, was with his friend Delaye, the author of the localization in question. Our own experience has shewn its accuracy in many instances. Dr. Bright and the late Dr. Sims have furnished examples which tend to confirm it, and lastly the very cases which are adduced by its opponents, when sufficiently detailed, offer the explanation of the apparent exception. As a general remark, it may be observed, that this localization cannot be made or relied upon in many recent cases, since the parts in the vicinity of the clot may suffer to a degree which interferes with the function, although the absolute Lesion may not extend to them. In the process of recovery there is a marked difference in the returning power of the paralyzed members corresponding with these uninjured portions of the brain,
The fifth class, or that comprising the morbid secretions, relates first, to the serous effusions of Dropsies. The introduction of Asiatic Cholera into this division appears to be of questionable propriety. Secondly, to the mucous secretion of which bronchorrhoea, gastrorrhea, catarrhal diarrhæa, leucorrhoea, and vesical catarrh are particularized. Thirdly, the proper secretious of special organs, such as the saliva, the bile, the urine, milk and semen; and fifthly, morbid secretions, all the examples of which group consist in the preternatural development or accumulation of air or gas.
In the sixth class, which comprises the effects of poisons, the author adopts the classification of Vicat, modified by Orfila, and makes sur divisions according to their mode of action upon the system: viz. 1, Irritating Poisons; 2, Narcotics; 3, Narcotico-Acrid; and 4, the Septic or Putrescent. Though the most convenient classification, it has its defects and difficulties ; and the author refers to the remark of Mead, that the same poison will act differently according to the dose and mode of application, and cites in illustration preparations of lead, which, though ranked with irritating poisons, exert a widely different influence after their absorption, - “Many poisons are taken into the alimentary canal ; others act when they have been applied to other mucous membranes, or to the skin, more especially when denuded; or they may have been applied to a wound or introduced into the cellular membrane."
Whatever may be the mode of introduction into the economy, poisons may be limited to a local action, irritating or disorganising the tissuessuch are the concentrated acide, potash, &c. Others producing no effect on the surfaces with which they are brought into contact, act on more or less distant organs after they have been absorbed. This is particularly the case with opium. Some poisons have a complex action. They first inAame the structure to which they are applicd, and then, a portion being absorbed, occasion similar lesions in other organs. Such, for example, are cantharides, which, being swallowed, inflame some parts of the urinary passages. Others exert their force on the nervous system, either causing excitement or insensibility, without producing any material change of tissue, Such is the action of nux vomica and tobacco. Lastly, there are some poisons which, being absorbed, act primitively upon the blood and change its composition. Many poisons, but especially the several kinds of morbid virus, are of this description.
We see, then, that a great number of poisons are absorbed. This ab. sorption, which but a few years since was unknown in the case of some
substances, and rather admitted on physiological inference in the case of others, has been demonstrated by experiment by Orfila, who has discovered most mineral poisons in the tissues of several organs, in the blood, and in the urine. A new path has thus been opened for legal medicine.
Most poisons act immediately, but others produce their specific effects after the lapse of days, weeks, or months, requiring what is termed a period of incubation, as in the case of poisoning by different kinds of morbid virus. The symptoms which are induced by poisons have generally an acute or hyper-acute character, and some persons have even denied the existence of slow or chronic poisoning, yet we have undoubted instances of this kind in the influences of lead or mercury. The old notions of a slow poison by which death may be insured at a fixed distant period, was an idea produced by ignorance and maintained by popular prejudice, and may be regarded as contrary to the laws of nature. Chronic visceral disease, either produced spontaneously or the sequela of an acute affection induced by poison, may have been frequently mistaken for cases of slow poisoning.
Symptoms dependent on disease of the abdominal viscera and derangements of the cerebro-spinal system may bear some resemblance to the effects of poison, as in indigestion, iliac passion, cholera, peritonitis, hepatic and nephritic cholics, certain nervous affections, and apoplexy of the brain and spinal cord. In general, inspection will remove the doubts which may exist; but when the investigation of the symptoms, and the inspection, aided by the microscope, are insufficient, recourse should be had to a chemical analysis of the excretions, and likewise of the organs themselves.
We pass over the author's remarks on individual poisons of the acrid narcotic, and narcotico-acrid classes, and give his enumeration of the putrid or septic poisons. We may, however, just observe that, in treating of poisoning by arsenious acid, he confirms the recommendation of the hydrated oxyde of iron. If this be not at hand, the aperient saffron of Mars may be substituted for it, but in larger doses. The antidote is to be given after the mechanical irritation of the fauces has been employed to produce the rejection of the poison by vomiting. We have employed the hydrated oxyde of iron in a case in which about two drachms of white oxyde of arsenic had been taken. Success in this instance was complete, the patient being perfectly well in the course of a few hours. But in this case repeated powerful evacuation of the stomach had previously been produced, by forcing the patient to swallow several raw eggs, then dosing him with a solution of the sulphate of zinc, followed at intervals by copious draughts of warm water. The energetic and copious vomiting brought away considerable quantities of arsenic in substance. We have known the white oxyde of arsenic to be retained, after an emetic of sulphate of zinc had been employed in the usual mode ; which is not surprising, when it is considered that one of the effects of the arsenic, taken in substance, is to excite the effusion of lymph, by which the arsenic is entangled, and retained in contact with the stomach. This will account for one of the most remarkable cases on record, in which a young woman survived the swallowing and retention of a large dose of white arsenic, which, some months after, was discovered shut up in a membranous cyst attached to the lining of the stomach.
The effects of alcohol are mentioned among those of vegetable poisons, 1847)
Lesions of Nutrition-New Growths. and the general or partial combustibility of the body is recognised as one of its rare but undoubted effects. When general, this combustion may be rapid, and completed in two or three hours, or even in a single hour. This form is mostly met with in aged females, whilst the partial combustion has been more often noticed in men. The simple effusion of cold water seems to accelerate, rather than stop, the combustion, which, however, may be subdued by prolonged immersion in very cold water.
Under the head of Septic Poisons, the following are included :-Putrid exhalations ; putrid articles of diet; putrid matters applied to wounds ; ergot; maize; gas from cess-pools and drains; animal poisons, as of the viper, the rattle-snake, the scorpion, the wasp, &c.; the several kinds of morbid virus, as of syphilis, yaws, hydrophobia, malignant pustule, and farcy or glanders.
7th Class.-LESIONS OF NUTRITION. The subdivisions under which the author arranges the affections comprised in this class are,
Ist. Hypertrophy, specifying that of the brain, spinal cord, heart, liver, spleen, thymus and thyroid glands, and Arabian elephantiasis. Cirrhosis is introduced as hypertrophy of the liver, but constituting a separate form. - 2ndly. Atrophy—-viz, of the brain, spinal cord, heart, liver, and biliary ducts.
3rdly. Induration of the brain, spinal cord, heart, and liver.
4thly. Softening-of the brain, spinal cord, heart, stomach, intestinal mucous membrane of the liver, spleen, uterus, and bones.
5thly. Gangrene-specially noticing that of the lungs, the mouth, pharynx and vulva.
7thly. Those lesions which produce the contraction, obliteration, dilatation, perforation and rupture of hollow organs. Under this head are noticed the openings of the heart, contraction and obliteration of arteries, veins, and sinuses; contraction of the air-passages of the æsophagus and intestinal canal ; dilatations of the bronchi and pulmonary cells ; dilatations of the heart and of the lymphatics, aneurisms, dilatations of the pharynx, cesophagus and stomach-Ruptures of the esophagus, stomach, intestine, and parietes of the heart; Ruptures of the tendinous cords of the heart; Preternatural communications between the cavities of the heart; Ruptures of the aorta; rupture of the lungs and pleura, producing pneumo-thorax; rupture of the diaphragm; rupture of the spleen, liver, kidneys, and gall-bladder; ruptures of the urinary bladder and of the uterus.
Class 8. In this class, which comprises structural changes and accidental productions, there are two principal divisions—the first consisting of those diseases which are characterized by the transformation of tissues, or by the development of new tissues analogous to or identical with those which are natural to the body ;—the second are marked by the existence of new pro'ucts, altogether abnormal.
The furst of these divisions comprises fatty, serous, corneous, cartila
ginous, and osseous formations, and some forms of polypi. In the second class are included inorganic concretions, entozoa, cancer, tubercle, and melanosis.
In speaking of cysts, which he regards as the accidental production of a serous tissue, he notices their occurring sometimes solitary and sometimes in great numbers.
“ We sometimes,” he observes, "find so many in the same individual, that it has been supposed that their production depends on a particular diathesis. Such is the case of a woman related by Morgagni, in whom he found 800 serous cysts, disseminated in most of the viscera.
" The mode of formation of cysts has been a subject of much discussion. Some consider, with Louis, Haller, and Morgagni, that the effused material is pre-existent to the cyst, whilst, according to Bichat and Craveilhier, the opposite takes place. The latter opinion is probably more generally correct. It is, however, indisputable, that in many cases the formation of a cyst is consecutive to the presence of a foreign body. Such, for example, we have seen to be the case with colle ons of pus and blood in the brain. It is also seen when bullets are lodged in the substance of tissues.”
Cruveilhier's arrangement of cysts, which is very good and practical, recognizes these and various other forms of cysts.
In speaking of particular forms of cysts he notices specially those of the brain, those of the liver and spleen, those of the kidney, the dilatation of the pelvis of the kidney, caused by some obstruction in the passage of the urine to the bladder, to which the name of Hydronephrosis has been given by Rayer, who has well described the affection, Ovarian Cysts, which he divides into the hairy, the serous, and the acephalocystic.
Ovarian cysts, containing hair, are often accompanied by teeth, generally those of the first dentition, portions of bone, apparently belonging to different parts of the skeleton, skin, muscular tissue, and a greyish-white matter.
“ The origin of these productions has been much disputed, but we think, with Haller, Cruceilhier, and Velpeau, that they appertain to fætal debris. It must be admitted that, in the cases of which we are speaking, ovarian pregnancy had taken place; that the fætus, having perished at a more or less early period from conception, had been almost entirely dissolved, while certain parts had resisted destruction, or even continued to grow. Such are the hair and even the teeth, which sometimes acquire considerable development. The interest of these tumours is almost wholly of an anatomico-pathological character, as they generaily remain stationary during life, producing little distention or derangement of health. They may however be accompanied by inflammation, and attended with symptoms observed in other cases of extra-uterine pregnancy."
We do not admit the author's explanation of the origin of these cysts as applicable to all cases.
Of the serous form of ovarian cysts he speaks at greater length.
“ Serous cysts, which are rarely met with in other parts of the body, are very frequent in the ovaries. The peculiarity is explained by the structure of these organs, which contain within their interior fifteen or twenty small vesicles, which are probably the most frequent starting points of the malady. The tumour, however, does not always begin exactly within the ovary. Soinetimes it is external to it; that is to say, immediately under the peritoneum, but without the fibrous