Retrospect of the Medical Sciences

1842 BMJ (Clinical Research Edition)  
in his Gulstonian lectures for the present year, speaking of the causes of sudden death, attributes it in many instances to an interruption of the coronary circulation. He thinks that ossification of the coronary arteries, a fatty condition of the heart, a contracted aortal or deficient mitral valve, may, by interrupting the flow of blood through the coronary vessels, give rise to syncope or sudden dissolution, according as this is more or less imperfectly impe'ded; and that when entirely
more » ... when entirely arrested, the heart, being suddenly paralysed, may have its action stopped for ever. To determine the effect that the arrest of the coronary circulation would have upon the action of the heart, Mr. Erichsen performed a series of experiments on dogs and rabbits, seven in number. The animals having been pithed, the heart's action was sustained by artificial respiration, the chest opened, the coronary arteries and veins tied, and the subsequent duration of the ventricular pulsations' noted, which, with the exception of the second experiment, gave an average of twenty-three and half minutes after the application of the' igature, -while in an animal that has been pithed, and the heart remains intact, artificial respiration will keep up the cardiac pulsation easily for an hour and a half. When the coronary veins, which are necessarily included in the ligature, are punctured afterwards, so that venous congestion of the muscles of the heart does n'ot exist, the action of the organ does not continue so long.-Medioal Gazette, July, 1842. ENLARGEMENT OF TILE HEART FROM RHEUMATISM. Mr. Lawrance details the case of a boy, fourteenyears old, the subject of acute rheumatism, who was also laboring under evident hypertrophy of the heart. This last named affection was first perceived in January, 1830. On the 10th of December, 1831, he was again seized with rheumatism attended with high inflammatory fever, of which he got better, but a relapse occurred, the heart being attacked, andhe died suddenly on the 31st ofthe same month. On examination of the body, the pericardium was found to be enormously distended, and before it was opened, measured seven inches and three quarters across in a horizontal direction. It contained twelve ounces of bloody serum. It adhered to the heart at the base, and also by vascular produictions in other parts; its internal surface was of a dark red color, and covered with rough projecting papille, which were also found on the muscular substance of the heart. The heart itself was very much enlarged and hypertrophied, and there was a pendu. lous fleshy projection of a cartilaginous hardness, nearly an inch long at the upper part, near the origin of the left auricle. The organ was highly vascular, and on opening the cavities the interior lining of the auricles and great blood-vessels was found to be of a deep red color. Together with its investing pericar. dium, the fluid having been evacuated, it weighed one pound thirteen ounces, avoirdupois, the average weight of the heart of-an adult male, according to Dr. Clendinning, being nine ounces, avoitdupois.-MAled. Chir, Rev., July, 1842. FRACTURE OF THE SPINE AND STERNUM. Three cases of fractured spine, the sternum suffer. ing by contre-coup, are recorded in the annual surgical report of the Hotel-Dieu, published in the " Gazette Me'dicale." In each of the three cases there was complete separation of the first bone of the sternum from the second, the latter having passed up in front of the former, and causing a considerable projection. The organs of respiration and circulation were uniffected. These cases of fracture, with the exception of those recordedby David and Chaussier, are unique. A painter, while engaged at work on the walls of a church, fell from a height of twenty-five feet, the body in supination and across, on to a bench; there resulted fracture of the fourth dorsal vertebra, with complete paralysis of sensation and motion, and such a state of tension at either end of the sternum, as to separate completely the first bone from the 'second, this last btne being thrust forwards by the ribs, which were also propelled and drawn upwards by the contraction of the pectoralis major. The poor-fellow survived forty days. Although the fracture was fully reduced, there was not any attempt at union. In a second case, the man, who had fallen from a great height, was brought dead to the hospital. In addition to the leparation and displacement of the first and second Zones of the sternum, there was complete diastasis of the articulations of the pelvis, considerable ecehy mosis of the sub-peritoneal cellular tissue, fracture if the seventh cervical vertebra, and dislocation backwards of the right wrist, with fracture of the carpus. There was not any contusion on the anterior paries of the chest, and from the great separation of the bones of the pelvis, without the lower extremities having been bruised, it may be inferred that the man fell first on the nates, and then on the upper part of the spine, for both sides of the seventh cervical arch were broken. The fracture of the sternum must have resulted from its great tension and the contre-coup. The third case occurred in the person of a man who fell upon the back, the fifth cervical vertebra being fractured, whence resulted loss of sensation and motion in the upper and lower extremities. The first bone of the sternum was in this case also separated from the second by contre-coup. A singular symptom, that of constant piiapism, continued during the five days that the man survived the accident. A fourth part is reported from the H6pital Cochin, in which the patient, an athletic carrier, fell from a considerable height on his feet on to a scaffold, and then fell back on the spine and head. The result was la grinding of both ossa calcis to powder, fracture of the spine, and of the the left side of the cranium, wVith depression, and simple oblique fractu're of the third bone of the ster. utim. The patient died in two days. HYPERTROPHY OF THE TONSILS. Children and adults are subject to an hypertrophied condition of the tonsils, which is, on the other hand, very rare in old age. The chief cause is repeated attacks of inflammation, although it may occur without having been preceded by any inflammatory attack. X is a mere infirmity, not a disease, life being rarely it ever put, in danger, and the hypertrophied tissue
doi:10.1136/bmj.s1-5.108.81 fatcat:t3536plsm5dhln6c7ljnrp6y64